We would like to share a recent email that we received from our pilot farming cooperative in Nyange…..

Report of activities of DUTERANINKUNGA Association

       Hello Wendy; how is your news? For us we are well.

        DUTERANINKUNGA Association wants to wish you the good Labor Day.

       We wish to send you the report of activities DUTERANINKUNGA Association.

1.      We already finish cultivating the Ground and on the photos, you find that the culture are well because we have the rain season.

2.      We still prepare the materials to build the cow House.

We didn’t build it because we have the rain season, it rains a longtime the reason why to build in this season became difficult, on the photos you find the briquettes for building and photos of cultivated ground.

We hope that we will have sufficient  harvest because we had the good time.

Now the Project is well, we didn’t have the problems

Thank you; you will Great our Friends.

GOD bless you for your Help.

This is our onions….

 

This is our Eggplant and other vegetables in the ground...

This is our cabbages...

Our soybeans in the ground.....

And Our Mango Tree....

In March 2012, TIP collaborated with the William Davidson Institute to bring a Multidisciplinary Action Project (MAP) Team to work with Ruli District Hospital and their associated health centers. The team spent 4 weeks building upon last year's University of Michigan Ross School of Business team's recommendations to develop a communication system that will improve the flow of patients referred to the hospital from throughout the rural catchment area of Ruli District Hospital. Based upon initial recommendations, the Ministry of Health initiated a simple system that would allow the hospital to more reliably predict outpatient referrals from health centers. This improves the efficiency for hospital outpatient services, and improves the the patient experience by decreasing wait times and minimizing the risk of coming to the hospital without being seen by a physician. The MAP team worked with the hospital and health centers to assess the implementation of this new system, including current work flows, to determine areas of strengths, weaknesses, opportunities and threats. In June, a WDI Fellow will spend 3 months working with Ruli District Hospital to assess and implement recommendations, as well as field test the recommendations and survey stakeholders for their input. Once recommendations have been fine-tuned and field tested, they will be expanded to all health center/district hospital service areas throughout Rwanda. This is a great example of how on-the-ground assessments, stakeholder interviews, and collaborative design can improve health system efficiency and provide a positive impact on patient care!

Huffington Post story by Suzanne Skees shows what happens when social-change activists from two continents ask what’s needed and then design sustainable solutions together.

 

Suzanne Skees

To view the original piece, click here. 

Julienne was just four during the 1994 genocide. She is HIV-positive and works as an artisan for this member-owned women’s collective through The Ihangane Project. Ihangane brought solar lighting to the health clinic where she gave birth safely without transmitting the virus to her 4-month-old son, Kingi; they also provide nutrition supplements for Kingi and gardening and nutrition training for Julienne.

Ruli: Rwanda: Far up in the hills of central Africa in a village called Ruli, families live as do 90% of Rwandans, working the land. To get to Ruli, you have to go off the map, over 2.5 hours of bumpy roads, winding your way northwest of Kigali; and you have to be willing to leap backward in time. Here, people live mired in the past, swinging hoes and hoisting water, centuries behind in infrastructure, yet also suffering the aftereffects of a more recent past — the 1994 Rwandan genocide.

Already challenged by poverty, this land-locked country with a legacy of colonizer-instilled tribal conflict experienced decades of violence that culminated in a gruesome genocide of nearly 1 million Tutsis and Hutus. Another 2 million fled to hellish refugee camps in neighboring countries. Houses burned, livestock died, fields languished, and the economy nosedived. It took years to discern whom to prosecute and forgive, who owned what, and how to live together again. Women were widowed, children orphaned, and an already-high prevalence of HIV skyrocketed among women survivors of rape.

Dr. Wendy Leonard practices family medicine and HIV/AIDS/TB care in California and Rwanda.

U.S. physician Dr. Wendy Leonard decided to take action. She boarded a flight in 2006 as the first physician volunteer for the Clinton Foundation’s HIV clinical mentoring program in Rwanda. They sent her to a remote village called Ruli, and told her to oversee government health initiatives. She found, instead, that she had a lot of listening — and learning — to do.

"It’s really about understanding who it is you’re trying to help," Wendy says. "Every time I’m in Rwanda, I learn more about the people and the culture."

The first week on the job, Wendy’s mentor, Dr. Jean de Dieu Ngirabega, told her, "If you want to help our community, you must first get to know us." He took her to a local wedding, a Catholic/traditional ceremony that carried on all day. Hundreds of guests sat patiently in searing heat on wobbly wooden benches, trading stories and gossip, watching a never-ending procession of neighbors bearing gifts in agaseke, hand-woven lidded baskets borne atop women’s heads filled with rice, beans, seeds — anything the new couple may need to start their life together. The father of the bride presented them with a cow. Wendy knew the hosts were among the poorest of Africa’s poor, and all her theories about charity evaporated in the stifling air as she watched them feed every single person who showed up.

"Everyone gets a Fanta, and everyone gets fed — even if only corn on the cob," she marvels. "No matter how poor you might be, everyone provides for each other." She saw this practice again at the clinical level. For example, surveys revealed that 200 community health volunteers wished for increased nutrition training — not salaries. "It makes sense to try and raise funds to pay even a small stipend," Wendy reflects now, "but just by asking, we discovered that was not their motivation at all."

Then, the doctor from America flipped the model — from top-down development to community-based grassroots–and launched The Ihangane Project in 2008. The name means being patient; its mission is to improve healthcare and economic development. Ihangane is "just facilitating what Rwandans are already doing," Wendy explains. "All our projects are initiated by Rwandans. We always ask, What can we do to strengthen their capacity?"

45-year-old Dr. Avite runs the 168-bed Ruli District Hospital, where he sees patients for accidents on motorbikes and in "unofficial local mines"; cardiovascular and cirrhosis problems. Throughout Rwanda, the population suffers a high rate of alcoholism and PTSD, anxiety, and depressive disorders: Part of the legacy of the genocide. Dr. Avite and his wife have three adopted teenage children.

Ihangane provides technical and financial support for community-created models:

• artisan sales by microenterprise collective
• cross-sector collaborations
• solar power initiative
• maternal and infant care

• rural hospital improvements
• local healthcare linkages
• nutrition, gardening, and pig-farming projects

Ihangane aims for self-sustaining solutions that soon will graduate from donor inputs. "For example," explains Wendy, "for HIV-exposed infants in Ruli at high risk for malnutrition, we provide sosoma, a porridge of soya, sorghum, and maize fortified with vitamins and minerals. This supports one of the many truly beautiful protocols from the government [Ministry of Health]; but the funding is not there. So, we are building farming collectives to grow component grains. We’ll grow locally and sell to Ruli hospital at a much more affordable cost. The farmers also can sell their surplus crops for an additional profit."

The day we visit, rain falls softly at the top of one of Rwanda’s "thousand hills," and the red soil looks rich. However, this land has been stripped by one-crop farming and poisoned by toxic pesticides. Many farming families have been reduced to a diet of rice and maize. Banana trees carpet the hills, yet only a few still produce fruit — often used to make beer. Now, Ruli residents have asked for diversified garden inputs and training on how to grow high-yield crops and cook nutritious meals.

American MBA students learning on the job: four University of Michigan interns are spending four weeks in Ruli, testing an SMS-texting system of communications between district healthcare centers and the main hospital to improve patient care. They sleep in the local church. They’ve been amazed by the beauty of the land and the kindness of people here, and report a fondness for Rwandan cuisine and the local beer.

The main hospital has electricity; however, several of the eight outlying health centers previously had no power. Women who went into labor at night had to give birth in the dark. "Now we have solar lighting in eight health centers," Isaac, an Ihangane volunteer and lab technician, tells us. "We can light the maternity ward 24 hours a day, power a microscope and a radio phone used to call for an ambulance if needed." Partnering with Catapult Design, "the Ihangane solar project is just on time," Isaac smiles.

Gratien, another intern, bicycles from his father’s nearby farm to help the Ruli Women’s Cooperative launch a pig farming enterprise in nearby Nyange. Livestock farming will diversify their income and allow them to increase their membership. "Pigs are simple," Gratien laughs. "They are not complicated. They need only a small pen. They eat slop." Ihangane will raise funds for initial building and livestock materials, and then Ruli will take it from there.

A few of the thirty artisans of the Ihangane Women’s Association. Each member pays $25 to join. They put 10 percent of profits into savings, create group loans for one another, and divide the remaining 90 percent among members. Founding president Madeleine (far right) taught the members to dry sisal fibers, dye them, and weave into traditional wedding baskets. They also produce cards, pictures, and jewelry.

"Sometimes when we want so badly to help, we just come in and try to help," Wendy muses. "If we come in to learn who they are first, sometimes we find amazingly rich resources already in the community." For the artisans, Ihangane provided startup materials, and will provide follow-up training through local fair-trade expert from Rwanda Economic Development Initiative (REDI).

For the grandchildren of the genocide like baby Kingi, across Rwanda’s 15,000 rural villages, the future looks brighter — maybe. Currently, 12 million residents crowd into a country the size of Maryland; 43 percent are under age 15, and 46 percent of children under five suffer chronic malnourishment.

However, Rwanda promotes equality for women (more than half their members of Parliament); public education for all (now through 9th grade, soon to extend through 12th grade); economic development (GDP rose steadily 6 percent per year during the global economic recession) through enterprise (Rwanda aims to become the business/IT hub of Africa; currently it takes just six hours to set up a new business here). President Paul Kagame says, "Poverty contributed to the genocide. If that past is never to happen again, we must grow our economy." The way forward yokes education and enterprise–"enlightened self-interest"–as Head of Strategy and Policy Serge Kamuhindu puts it. "What we want is a second chance for everyone born in this country," he told us at the Hôtel des Mille Collines (Hotel Rwanda) last week.

The future belongs to growing leaders across Rwanda.

A second chance — and a healthy start — is what Ihangane wants for Kingi, and all the youth who will build a prosperous, healthy future rooted in the best of Rwandan culture.

REDI is a non-profit organization founded in February of 2010 with the main objective of proving strategic trade-related assistance to the small holder coffee farmers. It is engaged in the entire value chain of improving production and building up sustainable market access through improvement of business performance, increasing market linkages and quality production supply.

REDI Mission:

To provide support and technical expertise, institutional and financial capacity building for coffee cooperative members to meet the requirements of the international Fair Trade certification.

REDI Vision:

To improve the living standards of cooperative members and their families through members’ empowerment, education for better community health, and a healthy environment.

REDI Values: Empowerment, Fair Trade, Partnerships,Transparency, Accountability, Sustainability, Efficiency, Participation, and Profitability.

Main Activities of REDI

Negotiating financial support for processing and marketing operations

Sensitizing new cooperatives to obtain Fair Trade certification

Supporting cooperatives to meet all standards requirements

Encouraging and promoting women in the coffee sector

Capacity Building within the cooperative to ensure that all systems are in place

Participating in national and international producer conferences and exhibitions

Producer trainings, exhibitions, and workshops

Core Objectives:

Increase and strengthen the capacity of farmers’ cooperatives with particular attention to those involved in the coffee sector

Optimize the benefits given such organizations to their members and vice versa

Strengthen the capacities and abilities of the executive secretaries, the cooperative management and staff, and the representative bodies of the organizations, improve the overall business performance of farmers, rural business people and their organizations.

Promote the women’s agenda and perspective operating in the sector

Collaborate with other national and international organizations

Improve the socioeconomic welfare of the farmers through:

•  Fighting against HIV/AIDS & stigmatization of people living with HIV/AIDS
•  Sanitary education and Family Planning
•  Adult Literacy
•  Education for environmental education and literacy

This summer, Stephanie Blount provided us with a beautiful report that outlines recommendations for how to support these cooperatives in their path to business independence and sustainability.  Here are some excerpts from this report…..

“[A cooperative is] an autonomous association of persons united voluntarily to meet their common economic, social and cultural aspirations through a jointly-owned and democratically-controlled enterprise.”

– Official definition of ‘cooperative’ according to Rwanda MINICOM

“Independence” can be defined in a variety of ways. The implicit assumption is that independence in this context should be equated with some measure of monetary success. However, The Ihangane Project recognizes the utility of a multi-dimensional reading of the word. Indeed, even the Oxford Dictionary definition: “Freedom from control, influence, support, aid, or the like,” suggests that the concept itself is of utmost complexity, and its interpretation very personal.

COOPERATIVE GOALS:

The discussion of “goals” occurred rather early on during my time in Rwanda and perhaps as a result, the level of communication was not as strong as I would have liked. Individual women seemed to have different interpretations of “goals” – some were expressly more business related, and others more personal (see section on Household Assessments). But some coherent themes emerged which I classify into 3 distinct sections below. I also include a fourth section which I believe to be just as important but which was not mentioned by the women. I believe that the women of both Ihangane Women’s Association and Covaru Cooperative would equate achieving these 4 Goals with achieving “independence” and “success”.

I will have reached my Goals if I can…

1. … make an income large enough to sustain my family.

2. … become a skilled artisan who makes craft work of the highest quality in Rwanda.

3. … acquire business skills and a business-minded approach.

4. … become self-assured and confident in my abilities and personal value.                

SWOT Analysis:

To achieve the goals outlined above, a robust business plan must be developed. A SWOT analysis will provide the groundwork upon which to build this plan. The outcomes of this analysis will dictate the “next steps” taken on the road to independence. Below I outline the strengths, weaknesses, opportunities and threats of Ihangane Women’s Association and Covaru Cooperative.  There will be areas of significant overlap in the SWOT analyses of both. However, the groups do possess some fundamentally different characteristics that are a function of their history and group make-up. For this reason, I will list shared strengths and weaknesses together and provide a separate list of attributes that are applicable to each group respectively. It is also important to note that at times, even shared characteristics may differ in subtle ways. I will elaborate upon such nuances in the recommendations section. I do not distinguish between opportunities and threats for each group respectively as the external characteristics that may benefit or harm both cooperatives are the same.

Shared Strengths: The value that already exists within the business

·         Community ties and connections
·         Natural Resources and Access to low cost Materials
·         Capacity for Increased Production

Ihangane Women’s Association Strengths

·         Commitment to Business Success
·         Skills Knowledge- some members have extensive experience making traditional crafts

Covaru Cooperative Strengths

·         Association History
       Spirit of Independence
       Group Cohesion
       Innovation

Shared Weaknesses: Characteristics internal to the business that require improvement

·         Internal Performance measurement- measuring their performance or determining “success"

      Innovation and Skills Strengthening

·        Power dynamics - Some cooperative members hesitate to express opinions/ideas to the leadership and broader group. This could be a symptom of a number of issues including low self-confidence, a lack of understanding of the expectations of membership in a cooperative etc.

      Location- Trends in handicraft design are set in the nation’s capital and Ruli is a 2+ hour drive from Kigali.

Fostering Empowerment and Self-Efficacy:

Another item worthy of note is that of the 12 home visits conducted, 9 were at the homes of Covaru members. At first I assumed there was simply more enthusiasm within the Covaru group about my involvement, but in retrospect I believe the Covaru women were more aggressive about wanting me to visit than the Ihangane women. I don’t think the fact that Ihangane is comprised of a number of HIV+ women is incidental to this outcome. Self-confidence and personal value is undoubtedly lower among the women of Ihangane Women’s Association. This was apparent not just by the fact that fewer Ihangane women approached me to visit their homes, but also in the content of conversation I held with women of both groups. Covaru women would ask me pointed questions about myself and about their business that Ihangane women never did. I have already suggested the importance of empowerment training for both groups, but the home visits solidified that this is especially necessary for Ihangane.

Measuring Success:

The principle differences between the women of Ihangane and Covaru turn out not to be explicitly monetary in nature; indeed the main difference on average is whether or not the woman has children. This may be a function of age as Covaru women are younger on average. (Of course, the fact that Ihangane women are more likely to have children does have some fiscal import because it means that they require more financial support to survive. But from the standpoint of the entire household, both groups experience equivalent financial instability.) Because their financial situations are comparable, is impossible to identify ‘indicators of financial success’ by comparing Covaru women’s experiences and Ihangane women’s experiences. However, by analyzing the group of interviews as a whole, I have singled out the following as potential specific indicators of financial success that would be useful to measure whether membership in either cooperative is yielding positive results in the women’s lives over time:

i. Existence of savings

ii. Number of children who have completed primary school

iii. Location of home – in or out of agglomeration

iv. Hours of free time per day

v. Number of animals/square meters of land purchased since joining

Kigali Field Trips:

I organized individual trips to Kigali for both cooperatives with the intention of exposing the women to the products manufactured by their stiffest competition. The idea was to position the groups in such a way that they were primed for self-reflection. Without leading them to the answers, I wanted them to conduct a critical comparison between their products and what they observed in the stores frequented by the consumers they would like to target. In all of our conversations prior to the Kigali visit, each woman opined that the main inhibitor to the businesses’ success was insufficient demand/lack of a market place. In the post-Kigali recap however, the women agreed that their primary inhibitor was comparatively low quality and a lack of innovation.

Acquiring an understanding of how to turn the concept of ‘innovative design’ into tangible products is critical for cooperative success in this field. Every store proprietor and sales person we spoke with during our tour of handicrafts in Kigali was explicit about the need for today’s artisans to take a novel approach to traditional handicrafts.

World AIDS Day is recognized around the globe on December 1^st of every year. This year marks 30 years since the beginning of the epidemic. Around the world, there were candlelight vigils, speeches, and red ribbons to honor those who were lost, those who have survived and those who now thrive despite living with this terrible infection.

This year, I had the extreme pleasure of being at University of California, San Francisco’s HIV Update conference. Not only is this a premier conference for yearly updates on the latest research and treatment guidelines, but the conference organizers generously provide The Ihangane Project a place to offer conference attendees access to our Rwandan crafts. It is a wonderful mix of dedicated medical professionals, many of whom have been leading the fight against the HIV epidemic since the beginning. We had the great fortune of listening to Dr. Paul Volberding, interviewed on stage by journalist Hank Plate, share his experiences during the early days in San Francisco. Several things struck me during his talk and documentary presentation. The first was a better understanding of the fear and trauma experienced by the communities hit hardest by the disease. There was uncertainty regarding the source of transmission for health care providers, as well as the terrible trauma of burying loved ones on a weekly basis.  This type of extreme trauma leaves scars that are often not seen initially, but that can shift one’s consciousness for a lifetime. The other important take home point for me was the incredible collaborative response that occurred in San Francisco during this time. Some of the most effective aspects of the response occurred when the medical community (at all levels) responded together with the Gay community that was being affected.  What an important lesson to recognize as we enter this era of rethinking how we organize our health care delivery systems around the world.

Dr. Volberding’s conversation with Hank Plante was followed by an eloquent presentation by Dr. Diane Havlir that was designed to instill optimism regarding the potential future (or end) of this epidemic. Indeed, our armamentarium of research-based approaches to prevention, diagnosis, and treatment of HIV inspires hope that we can dramatically turn the tide in the next decade. Dr. Havlir also emphasized that we MUST take the opportunity now. To wait may mean that we miss our chance at having a substantial impact on the direction of HIV/AIDS.

During this second presentation, my iPhone announced that I had received an email. It was our Rwandan partner, Dr. Ngirabega, who was responding to my recent email question to him: “will the Global Fund announcement to halt the next grant cycle affect Rwanda?”  Sadly, his response at that moment was “Yes. The Global Fund has cancelled the round of grant funding that Rwanda was going to request for 2013. This will affect many activities, and we will have to find other ways to provide services.” What a devastating contrast between the possibilities projected on the screen in front of me via Power Point and Dr. Ngirabega’s email message.

I firmly believe that AIDS Exceptionalism, and the resulting AIDS Fatigue, has played a role in leading us to this day. We founded The Ihangane Project for exactly this reason. We believe that long term success in curbing this epidemic will come from strengthening comprehensive health care infrastructure, addressing health care provider overwhelm, improving overall quality of health care, and erasing the socioeconomic barriers to good health. AIDS is a symptom related to marginalized communities and economic poverty, and cannot be addressed in a silo. That said, the strong push for HIV-specific programs such as PEPFAR and the Global Fund happened in response to the huge disparity between HIV care for the Global North and the Global South. Hundreds of thousands of people would have died due to lack of access to life-saving medications, and thousands of infants would have become perinatally infected with HIV if was not for the disease-specific outreach of these entities. It is true- it is time to pull away from the AIDS Exceptionalism approach that has frustrated so many Global Health experts. But, we cannot eliminate the very fabric that has brought us to this place in the epidemic. We are actually at a point that we can talk about ELIMINATION of HIV transmission to infants born to HIV+ mothers. How can we allow the Global Fund, with its commitments to our global partners, to disintegrate?!

We should learn from the mistakes made here in the United States. Domestic AIDS Fatigue hit as soon as the economy began to decline. In California, for example, 100% of funding for HIV prevention was cut from the State Budget in 2009. Since this time, our small community of Santa Cruz has seen the number of new HIV infections and syphilis cases more than double. Of course, by now, most people know how to prevent HIV. Unfortunately, these extremely marginalized communities no longer hear the message that they are worthy of protection and HIV prevention. Is this the message we will offer for the Global Epidemic as well? 

Learn more about the Global Fund cuts as bluntly described by Stephen Lewis at aidsfreeworld.org  

~ Wendy 
 

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Last month, I had the opportunity to attend Opportunity Collaboration. This is the third year that I was able to attend, and each year brings new thought-provoking insights. For those of you who do not know about OppColl, it is billed as the un-conference that brings “poverty alleviators” from around the globe to convene in Ixtapa, Mexico for 4 days of intense discussion. Attendees include representatives of social enterprise, family foundations, non-profit organizations, and community-based organizations from around the world. The design of the conference encourages conversation at all turns- during meals, during group sessions, and while swimming in the ocean. As one could imagine, the diversity of perspectives is immense. Although conflict would be understandable, this is the first year that I heard open discussion about these conflicts……hallelujah! We are finally getting somewhere!

Opportunity Collaboration is an eclectic mix of capitalists, environmentalists, socialists, do-gooders, financial bottom-liners, (and everything in between) from resource-limited and resource-rich communities. With this vast array of experiences, it is inevitable that we will see the world with different lenses. This year, I heard a wide array of complaints……here is a sampling of grumblings I heard….

• Funders feeling upset for being asked (or stalked!) for money – Funders are looking for relationships, as well as ways that they can positively impact our global community. They do not want to be reduced to deep pockets. On the other hand, many organizations (especially those coming from resource-limited settings) have broken the bank to get to Opportunity Collaboration and feel a pressure to return home with some sort of financial gain.

The following blog is composed of excerpts from a progress report written by current WDI intern Sean Morris.  It describes one of the many projects he is working on and some of what he has learned thus far.

CNW Program progress: I have assessed the community nutrition worker (CNW) program through direct observations of their work in the field, and through surveying large samples of CNWs from various health centers in the Ruli District Health System. My partner, Huriro Uwacu Theophila, is a biostatistics student at the National University of Rwanda.  We have worked to produce surveys in Kinyarwanda for both CNWs, and participants in the malnutrition program. So far, we have surveyed two of the seven Ruli Hospital CNW networks, and I plan to schedule transportation to the remaining five CNW monthly meetings as they take place in July. The information gathered in these CNW surveys includes: each individual’s satisfaction with the program; identification of resources necessary to perform their work; description of the food security situation in their villages; an assessment of the knowledge required to perform their work; and their current outreach to people living with HIV.  I will use the data from these surveys, along with the observations that I record in the field to see how far the CNW program has come in implementing the Rwandan community based nutrition protocols (CBNP), and to identify gaps in their effectiveness in combating malnutrition in their communities. After gaining a full understanding of the CNW program, I will work to determine cost-effective approaches to meet their material needs, and provide them with focused training and education opportunities related to nutrition. This survey has the potential to act as an on-going worker satisfaction and knowledge tool for the CNW program.  Such a tool would allow the CNW network and its administrators to continually, and accurately improve the program, monitor the success of any recommendations that we implement this summer, and foster collaborative problem solving within the CNW groups.  Improving the CNW program will advance the nutritional status of the villages in the Ruli catchment area, and will lead to reduced resource constraints, funding dependencies, and operating costs at the malnutrition center.

Satisfying moments and compelling experiences: One very encouraging aspect of the CNW assessment has been the enthusiasm and creativity I have witnessed among the CNWs themselves.  When they begin the surveys, or if I ask them directly about the improvements they want to see in their program, they tend to become very excited.  I sense that they are reminded of how important their work truly is in the fight against malnutrition in the district, and they relish the opportunity to share their opinions with someone who is genuinely committed to strengthening their program.  The survey results will be very useful in identifying points of intervention and improvement to their program, but the very act of asking them what should be done seems to inspire a strong pride in their work, and an increased stake in improving the nutrition situation in their villages. Apart from the responsibilities of my internship, I have been able to participate in the monthly community workdays – umuganda.  On the last Saturday of each month, every community member in Ruli will meet together to endeavor in a public works project.  Most recently I witnessed several hundred people working together with hoes and shovels to level a half-acre area of land, the future site of a new school building.  Such a project would have required a bulldozer, and an afternoon’s time in the US, but it would have lacked the social phenomenon of many people coming together to improve their community.  People would work, then take breaks to converse with their neighbors, and to point out the hilarity of the one American struggling to keep up with their work!  This communal connection to the development of Rwanda is not only vital to the growth of the town; it is also enormously beneficial to the social wellbeing of Ruli.  This idea is one that I will certainly take home with me, and work to include it in my future community. 

Today was a very sad day. Today, one of our participants in the Nutrition for HIV-Exposed Infants, Daphrose, passed away at the age of 39. To meet Daphrose, you would never know of the traumas she faced in her life. She was always smiling and laughing. The joy with which she played with her daughter was so very touching. She jumped at the opportunity to learn how to make baskets and banana leaf cards, although her true dream was to return to secondary school.     

What is not clear from meeting Daphrose are the losses that she carried with her. The first hint is within her home. She lived with her two brothers, and her sister next door, in a relatively new ‘umudugudu’. The home is large and well-made, although strangely lacking in furniture. There are wires that travel up the wall to an imaginary light bulb, but no electricity. The story is that her mother died when Daphrose was young. Her father lived in this home with his children, until a few years ago, when he packed all of the furniture (as well as the family’s lone solar panel) and moved to another community to begin a new family. Through this experience, the brothers and sisters became even closer and supported one another through the challenges that they faced. 

When Daphrose became pregnant for the first time, she thought this would be the opportunity to give her daughter what she had lacked. Sadly, this child was born with HIV and died shortly after she was born. She celebrated when her second child was HIV-. But, in a terrible twist of fate, her second child also died. This time, the cause was unclear but thought likely to be due to malnutrition after Daphrose stopped breastfeeding. When her third child was born, she was absolutely determined to avoid the tragedies of the past. She took her HIV medications diligently, followed all of the recommendations for breastfeeding, and joined our pilot group to ensure that her daughter would not develop malnutrition when she stopped breastfeeding. Indeed, her daughter thrived! She is HIV-, and did not suffer the complications of malnutrition as her other child had.

Life was looking good for Daphrose and her young daughter! Tragically, in January, Daphrose became very ill. She went to the hospital, where she was found to have an invasive form of pelvic cancer that is caused by the wart virus (HPV) and is stimulated by HIV infection. She was sent to the referral hospital in Kigali, only to be sent back to Ruli with the news that nothing could be done. Daphrose was in the hospital for 3 months before passing away from this aggressive cancer. Throughout her hospital stay, her sisters of the Ihangane Artisan Association visited her daily to provide food and emotional support.

 Her terrible loss is a reminder that there is still so much work to be done. Her passing weighs very heavily on our entire team, her family, her fellow program participants, and co-workers at Ihangane Association. Especially for the Rwandans who must watch these tragedies every day, it feels as though when they find a way to “plug one hole”, they lose someone to another hole. Despite this, their faith and perseverance carry them through and they continue to do their best. In Rwanda, I often hear “you must try” and “you can do your best”. For those like Daphrose and her daughter, we must try and continue to do our best.

Written on May 17, 2011 and posted later due to lack of internet access in Rwanda.