Baton Passed: Rwanda Takes Up HIV Care System

By Helen Blakesley,

Rwanda HIV

Epiphanie Uwiduhaye and her one year-old son Benoit, right, wait with Josiane Nyiranizeyimana and 3 month-old Fabrice for a consultation at Bungwe Health Centre in Northern Rwanda. Photo by Helen Blakesley/CRS

“Cleanliness is next to Godliness” my godmother used to remind me, as a rather impish child. Well if that’s indeed the case, Kigali, the capital of Rwanda is but a few steps from Heaven.

The main city of the land of “mille collines” – a thousand hills – so the French claimed, looks the picture of cleanliness, efficiency and order.

As I arrived here for my latest reporting trip with CRS, I drank in my surroundings. Pretty red brick homes with blue or terracotta roofs dot the hillsides. Grasses and flowers and trees are abundant thanks to regular rains (a spectacular growling of thunder presaged the next refreshing downpour as I gazed). People and vehicles carried on by, minding their own business.

This is a country where you’ll hardly see a scrap of litter on the streets, where street lamps are solar powered and moto-taxi drivers are obliged by law to wear a helmet – and have one for their passenger. There are smoking bans in certain public places and plastic bags are outlawed. Not only do traffic lights work, but they have illuminated count-down signs showing how long you’ll have to wait or how long you have to drive. After three years in the slightly erratic free-for-all which is my dear, adopted home of Dakar, I’m left agog with wonder!

Seventeen years ago, daily life in Rwanda was a very different story. In 1994, over the course of just three months, an estimated 800,000 Tutsis and moderate Hutus were slaughtered, mostly by Interahamwe militias – gangs of youths armed with machetes, guns and other weapons. It was one of the most savage genocides recorded in modern history.

But over the last decade or so, Rwanda has worked at putting the past behind her, with the aim of restoring peace and prosperity. Labels linked to tribal identity have been put aside as the government tries to build a new Rwanda, united under its new national flag depicting a blue sky of peace and golden sun of enlightenment.

What’s been achieved does seem incredible. And from what I can gather, the relative successes have come through a firm hand. Soldiers with guns are stationed at regular intervals to oversee the streets (I haven’t quite got the protocol down yet – do you look an armed man in the eye and say “hi” or do you just walk on and pretend he doesn’t exist..?) Criticism of the government is not looked upon kindly. Monthly “Community Work” days are obligatory, with a fine to pay if you don’t attend.

But, according to the people I’ve spoken to about their country, this “tight reign” is seen as necessary by many Rwandans, for the good of the nation. One lady even told me that people are worried about who would be strong enough to keep the country moving forward if President Paul Kagame were to step down.

The past hasn’t been forgotten though. The government organizes events each year for public mourning. Helping people to face what happened is part of letting go of the past and its horrors and divisions.

Rwanda hills

“The Land of a Thousand Hills,” offers this view near Bungwe Health Centre in Northern Rwanda. Photo by Helen Blakesley/CRS

The subject of ‘letting go’ got me thinking about the reason I’m here. I’m reporting on the transition of Rwanda’s AIDSRelief program into the hands of the government’s Ministry of Health. Catholic Relief Services leads the AIDSRelief consortium which has been strengthening health systems at project sites so that quality HIV care and treatment will carry on after the handover. It’s the first time an AIDSRelief program has transitioned fully to a government Ministry. Quite a daunting feat, and one which demands trust. The consortium can equip people with the knowledge and skills necessary, but then it needs to stand back, to leave the new coordinators room to stand on their own.

I was taken up into the hills – so high that my ears popped! – to meet staff and patients at one of the AIDSRelief sites, Bungwe Health Center in the Burera district, two hours North of Kigali. Volcanic summits looked placidly on as I met the center manager, Sister Yvette, a 60-something Catholic nun from Quebec, who’s been serving God and the people of Rwanda for nearly forty years. She took me to meet a group of HIV positive Moms who, thanks to prophylaxis treatment provided by the program, had been able to stop the virus being passed on to their babies. As I filmed them, waiting for their consultations, there was the swapping of news, there was laughter and there was every mom’s challenge … how to shepherd an energetic 2 year-old who wants to explore. Sometimes you just have to let go of his hand and trust.

Helen Blakesley is CRS communications officer for West and Central Africa. She is based in Dakar, Senegal.

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