If you have HIV, no income, young children depending on you, no partner/spouse, and live in a place like this, how would you survive?
Would taking your HIV meds be your first priority?
Partners-in-Health/Inshuti Mu Buzima (PIH/IMB in Rwanda) assists the Rwandan government and Ministry of Health in providing quality medical care to the three districts PIH/IMB serves. This partnership has delivered tremendous success. Over time, however, health care providers and program staff began to notice that for their most vulnerable patients, they were not seeing the type of medical improvements they expected given the medicines and treatments being prescribed. It wasn’t long before they realized that unless they treated patients more holistically and addressed their most pressing problems and needs, they were unlikely to comply with their medical treatments. This might not have immediately occurred to us back home — in our culture, we’re taught to “put your oxygen masks on first” before helping others!
Through a program called Programs on Social and Economic Rights (POSER), PIH/IMB is able to support patients and families by providing the things they need most, such as housing, food packages, medical insurance fees and school fees. POSER uses villagers from the communities they serve as Community Health Workers (CHWs). They are trained to educate patients and their communities on a variety of diseases; identify barriers to care; monitor progress; encourage compliance to treatments and otherwise support individual patients.
This type of support is much needed and goes a long way in improving the patients’ well-being. But what I found particularly exciting and innovative is how POSER goes even further by finding creative ways to help patients take care of themselves, raise their standard of living, and in some cases, give back.
After the POSER team receives a patient referral from local social workers and other health-care professionals, they carefully review the cases presented in partnership with local officials. I had the honor of visiting a couple of homes built by PIH/IMB, and met Celeste*, a single mother of five children (two of them adopted), in her early 40s and living with HIV. She was originally looked down upon by her village because of her disease and her living conditions. To help Celeste care for herself and her family, the POSER program gave her a cow and a house that is comparable to others in her village.
By the time of our visit, Celeste had sold her cow and wisely used the proceeds to buy several goats that have in turn produced several more — at one point, she had 22 goats! Celeste is also usually able to grow corn and other vegetables in her yard. Though this year’s drought has made things difficult, by selling some of her goats she’s been able to make ends meet. She told us that overall, she is better able to provide for herself and her children and she was even able to build an animal shelter (below). She is now considered a valued member of her village.
When Celeste first presented with HIV in the health system, she was very sick (luckily all her children tested negative). Now, with the help of the Community Health Workers and being able to meet her family’s basic needs, she is able to stay compliant with her medications and lead a much healthier and productive life.
Below is a picture of a sheep provided to one family (she already produced a lamb). Another family received a cow and the owner earns some income by selling the manure as fertilizer. Culturally, livestock (especially cows) are considered status symbols. Based on the region and climate, some animals are more coveted than others (e.g. sheep for Butaro, a colder climate and goats for warmer climates) so when families own livestock, they are soon viewed differently in the eyes of their neighbors, and of course, there are a variety of ways livestock can produce income.
But the POSER program doesn’t just help individual patients and their families. They also work with several patients in a given village and help them form and manage member-run cooperatives. I was able to visit one egg cooperative in Butaro (northwestern district of Rwanda) and a chicken and vegetable cooperative in Kirehe (Southeastern district). As a point of reference, the co-op model is not new to Rwanda as they help ensure fair trade — whether for hand crafts, fruit and veg markets, coffee, or even beekeeping (one of the latter was started to bring income to and stop animal poaching by neighbors of Akagera National Park).
The POSER program provides the seed money and/or the infrastructure (chicken coop, chickens, land, tools) to get the co-ops started. They also train the co-op members to manage their businesses. The group elects a leader from amongst themselves. PIH/IMB staff provides mentorship and advice, but the co-op members make all of the decisions.
The two-story egg cooperative in Butaro (below), houses several hundred chickens. Co-op members are able to harvest 500-600 eggs per day, enough to sell, provide for themselves and begin to pay back the PIH/IMB investment. There is also a demonstration garden at the site of the co-op in Butaro to encourage all residents to grow their own produce.
While visiting the chicken and vegetable co-op in Kirehe, the co-op leader, Claudine* took the opportunity to greet us and deliver a heart-felt and inspiring presentation. She thanked us for visiting and for PIH/IMB’s support. She explained how the co-op works (sharing visual aids of the ledgers and co-op members’ bank books) and finished by telling us about their financial success and sharing the challenges they face this year, such as getting water to their fields during this year’s drought. Claudine invited us to visit their vegetable field the next time we are in the area. I must say, her presentation was as thoughtful and eloquent as I’ve heard any corporate marketing director deliver! It’s exciting to see people come together behind a common goal and what they can achieve if they are respectfully given an opportunity and the right support.
I am excited about being able to help PIH/IMB, if even in a small way and I am glad to have you on this journey with me.
A little note about myself before I sign-off: I know it’s been a few weeks since I last wrote. Things have been quite hectic as Tamsin and I finally got our housing settled. Also, we GSK PULSE volunteers, joined forces with SAP (German Software company, similar to Microsoft) and their Social Sabbatical team of three employees to solve one of PIH/IMB’s technology challenges. This is the first time two corporate volunteer teams have come together on a joint project of this nature.
SAP was able to source, customize and pilot a centralized database repository and content management system at only a marginal cost to PIH/IMB. Those who know me are wondering what my role could possibly be on a technology project. Well, glad you asked!! I am introducing a change management process to the project team and consulting on the change plan to ensure employees stay informed, have input, and the system is well executed. Since the SAP program is only four weeks and given the visibility of this new initiative, you can imagine the sense of urgency and energy around the project. Luckily, GSK will be here a few more months to continue to support the project. So, I leave you with a slide show of the SAP/GSK team in “action” and our mini- safari to Akagera National Park!
Up next: An African-American in Africa — Blog #4 from Robin in Rwanda.
*Names and images altered for privacy