Impressions on visiting Rwinkwavu Hospital in Rwanda

Posted on Sep 22, 2009

When you leave the well-maintained highway from the capital city to go to Rwinkwavu Hospital, you turn left after a gas station in Kabarondo onto a dirt road. Rwanda is mostly a lush country, its celebrated hills covered in banana trees, tea plantations, and fragrant (if soil-deadening) eucalyptus. When you turn left after the gas station in Kabarondo, however, it's as though you've suddenly entered eastern Kenya. Like desert country everywhere, the savanna around Rwinkwavu has its own austere beauty, but limited water and dry winds that sweep away topsoil have made it one of the poorest areas in Rwanda. This is where Partners In Health chose to begin its work in the heart of Africa.

As with most structures in Rwanda, Rwinkwavu Hospital is built up the side of a steep hill. The higher you climb -- from the hospital itself to the new training center to the clean and pleasant housing for visitors and trainees on the summit -- the more you are convinced that it really isn't possible to go any further. One wonders whether similar doubts crossed the minds of the PIH visionaries who raised the funds, developed the programs, and forged the partnerships with local and national officials that now bring world-class healthcare to this impoverished corner of Rwanda. We can only be grateful for their continuing perseverance.

The hospital, reclaimed and transformed after the devastation of the genocide, is a series of single-story houses containing wards for women, men, children, and people suffering from tuberculosis. Although they are open wards, there is a homey feel to them. Parents and children in Icyumba cy'abana ("the children's room") chat amicably between beds and gladly engage with visitors who pause to greet them. Outside, patients stretch out in gardens of drought resistant trees, vines, and ground cover that have the shaggy look of someone's backyard, rather than the sharp lines and angles that characterize most institutional gardening.

Many of the hospital's interior walls are adorned with bright posters of healthy African children and adults smiling, playing, and serving in responsible roles. One corridor displays before-and-after photographs of people living with AIDS: a skeletal figure is restored in a year to robust manhood, radiating energy and purpose; a baby girl nearly wasted away in her mother's arms is able, two years later, to plant sturdy legs and thrust a chubby, mischievous face into the camera.

The healing of a human being -- the restoration of an emotional body that allows a soul to accomplish its unique purpose in the universe -- is an end of complete worthiness in itself. Yet PIH does not stop there. The hospital reaches into the communities that surround Rwinkwavu through its signature programs of follow-up medical care and accompaniment, peer support groups, nutritional supplements, and an agricultural assistance program partnering with the Heifer Foundation and the World Food Program. Improved agricultural methods allow families to make the most of small land-holdings, to resist erosion and enrich the soil that remains, and to grow enough fruits and vegetables to lift themselves out of malnutrition and make a little money on the side. Sensitive social support allows HIV-positive teenagers to stay in school and develop solidarity in the face of stigma, and helps couples and families stay together after the mutual accusations and guilt that often accompany an HIV diagnosis.

At the heart of Rwinkwavu's beautiful new training center is a courtyard garden with a small fish pond. Surrounded by four covered walkways, it has the air of a cloister garden at the center of a Benedictine monastery -- that open space that reminds us of the place in our own hearts that only the divine can fill. In my mind's eye, I see rays of healing extending from the open heart of Rwinkwavu Hospital into the whole of Rwanda. I see daughter hospitals in Kirhehe and Butaro Districts, and collaboration with health centers throughout the country. I see practitioners sharing hard-won expertise from Haïti with Rwandan counterparts adapting it to their own context. I see local training manuals and community education materials that will shape a national HIV/AIDS program. I see a heart for healing partnering the heart of a nation courageously working through its traumatic past and building a viable foundation for an exemplary future.

Climb the hill with PIH any way you can. The view is definitely worth it.

Jodi Mikalachki is an Education and Community Development Worker for the Mennonite Central Committee in Burundi.

[posted September 2009]

Dr. Paul Farmer sharing a friendly moment with one of his staff.

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PIH Founders - Jim Kim, Ophelia Dahl, Paul Farmer

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