Jhpiego's Blog

In Rwanda: Notes from Nemba

June 2, 2010 at 4:24 pm Leave a comment

By Leslie Mancuso

The morning rain has left the hills of Rwanda shimmering. Driving along the road, we pass Rwandans carrying an assortment of life’s needs—bundles of leafy greens, a sewing machine, a car battery—on their bicycles, in their arms, atop their heads. The caravan of men and women seems to stretch for miles as the road winds around and around, arching up and over swells of emerald green.

The land of a thousand hills: This lush landscape shows why Rwanda is so named.

With nine million people in Rwanda, the majority living in the countryside, farming is a way of life and the road to Nemba is a graphic illustration of the land’s importance—the hills are a patchwork of well-groomed gardens, landscaped gems of beans and vegetables. We continue to climb up the slope until we round a bend and find before us Nemba, a town on the Rwanda-Burundi border and our destination.

Jhpiego has been working in Rwanda since 2004, first with partners on a project funded by the U.S. Agency for International Development to improve services in malaria prevention for pregnant women, family planning,  maternal and child health and emergency obstetric care. Today,  the malaria work continues through USAID’s Maternal and Child Health Integrated Program (MCHIP), which Jhpiego leads. We also are working in HIV prevention and helping improve health care delivery in rural communities surrounding Nyungwe National Park.

In Nemba, we arrive to a tumult of activity and warm greetings from the mayor who thanks Jhpiego for its commitment to helping women give birth safely and raise healthy babies. From there, we head to the hospital in Nemba, where women, children and others are gathered in a spotless compound, waiting their turn for services

The need is evident—a pregnant woman has been carried in a big basket for miles by her family to the hospital. I feel certain that she will receive the best care that this devoted team can provide.

Prosper Niyitegeka, an accomplished male nurse who heads up our antenatal care unit, escorts me, Dr. Alain Damiba, Jhpiego’s Senior Vice President for Global Programs, and Jérémie Zoungrana, Rwanda Country Director and Chief of Party for MCHIP, toward a large white building, where we will meet the first line of  the town’s health care providers—the community health workers.

As we enter the room, the health workers rise from long, low benches and a group of young mothers, dressed in brightly colored skirts and tops, holding their children, burst into song:

“Mubyeyi uwuriwe wese wunva ubu butumwa, ubuzima bw’umubyeyi burakenewe, bitekerezeho cyane ukimara gusama, bubumbatire cyane ukimara kubyara, Abanyarwanda twese turabakeneye….”

“To every woman who hears this message, the life of a mother is so important, think about it from the conception, take care of your health and the health of your newborn after delivery, we all Rwandans need you.”

Their spirit and sincerity are undeniable. We are seeing firsthand the fruits of our work. These health workers are the underpinnings of the outreach to the community and the messengers of good health. So far, Jhpiego has trained more than 800 community health workers in Rwanda, and the goal is to have four in every village.

The women are taught how to record data—their very first mission is to identify all the women in a community—and build relationships and explain the basics of good health. They receive the fundamentals of a healthy pregnancy, safe birthing practices and danger signs of complications, which they share with pregnant women and their families. They also are trained in breastfeeding methods and proper care of a newborn.

The goal here is to reduce maternal and newborn mortality, to provide skilled birth care —fewer than 14 percent of Rwandan women give birth with a skilled provider present—and encourage women to deliver in a health facility.

Mothers with premature or low birth weight babies are given special attention and shown how to nurture their youngsters through the skin-to-skin, “kangaroo care” method. A baby is swaddled across the mother’s or caregiver’s chest and carried that way—with the help of other family—until the child gains sufficient weight.

But a health worker’s job doesn’t end with a healthy birth. She pays follow-up visits to the new mother and baby, checking vital signs and weight, and alerting moms to potential danger signs. She counsels women on  family planning.

The community health workers also examine other children in the family for signs of poor nutrition and provide supplemental feeding if needed. Health worker Musabyimana Consolee shows us how she uses illustrated cards and charts to teach women about giving birth safely. Good nutrition habits, treatment for diarrhea and malaria prevention are also shared with Rwandan mothers.

Before we leave, our hosts treat us to a delicious feast of goat kabobs, grilled potatoes and vegetable-filled pastries.

On the drive back to Kigali, I replay the joyous scenes from Nemba in my mind. The enthusiasm of the community health workers stays with me; I could feel their energy. I know they are helping women in their communities. All of Rwanda needs them. It was an empowering day.

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