10 Years in Rwanda: Leaders Reflect

Anatole Manzi
Director of Mentorship, Enhanced Supervision for Health Care and Quality Improvement

It was May 2005 when I heard about Partners In Health/Inshuti Mu Buzima (IMB). I was finishing my bachelor’s degree in clinical psychology, but I already had an advanced diploma in general nursing. Poverty, HIV, and other infectious diseases were striking my family members and neighbors. Specific words in the PIH advert, like “preferential option for the poor,” “social justice,” and “human rights,” were key for me and many other colleagues. I didn’t hesitate to submit my application for the nurse position.

After less than a week, I got called for an interview at Rwinkwavu Hospital. The facility was devastated—not enough nurses, no doctor, a limited number of patients, facilities in bad shape. I could not imagine this was the work I had applied for. Nevertheless, my dreams were to be with the sick and poor in a remote community. In my interview with Haitian physician Dr. Fernet Leandre (who played an impressive role in IMB program implementation, replicating the model from Haiti), he asked if I was ready to work in such a remote area. My prompt, sincere response was, “Yes, I am.”

Three days after the interviews, I got an offer letter. This remains the most exciting day of my career. Not many people could understand my reason for wanting to join this organization, but I was thrilled to join a team of people striving for the poor and sick, to rebuild the health system in my country. This was the work that I had long wanted, enabling me to have an impact in my community.

Holding an offer letter in my hands, I called my former employer and informed him about this opportunity. He told me that I should follow my dreams. And he gave me a promise that many employers would not make. He said, “I will keep your spot vacant for three months so you can come back if the reality you find is different from what you expect.”

My first day in Rwinkwavu was very instructive. We had an orientation meeting with Michael Rich who was the country representative for IMB. He mentioned that one of us had to be relocated to a different facility—more remote, with fewer staff and equipment, without public transportation facilities.

As a Christian, my first reaction was a silent prayer: “God, I do not want to be the one to go there. That would be too much.” That was my prayer. I thought God was going to perform a miracle and make Michael choose someone else.

Unfortunately, it did not take him any time to mention my name. It was shocking to me. I tried to bring up many reasons to stay in Rwinkwavu, but all were denied. I was sent to that health center named Rukira.

The first month was very challenging, but I was thrilled to see so many patients coming from all corners of the community. HIV testing and treatment services were new and much more comprehensive. So many patients were now on antiretroviral drugs. I was also amazed by the psychosocial support available to poor and vulnerable patients. I remember a number of them getting back to life after a short period of time.

When I was sent to Rukira, I wrongly thought that I would be alone. Instead, I received weekly visits from IMB physicians and nurses. We could see patients together, share lunch and dinner, and enjoy music together. This spirit of accompaniment kept my morale high. Despite their responsibilities as senior leaders of the organization, Dr. Joia Mukherjee, Dr. Sara Stulac, Dr. Henry Epino, and Dr. Michael Rich made time to see patients every week and boost the morale of staff, which had grown in the first three months.

Dr. Paul Farmer visited the clinic, too. The first time I met him, I didn’t know “Farmer” was his real surname. We spent our time planting flowers and digging a fishpond at the health center. After a couple of months, we had an amazing garden around the health center. It became a relaxing place for patients, staff, and local community members, and a favorite area for wedding photos. I thought he was an actual farmer.

After two years, in late 2007, I joined Drs. Peter Drobac and Patric Almazor in Butaro to officially scale up IMB activities. We had the blueprints for the future Butaro Hospital, but no one could believe that it was real. Within six months we had trained over 1,300 community health workers on HIV accompaniment and more than 150 nurses were trained in HIV management. Past patients performed gorgeous songs and drums at the one-year anniversary.

It did not take long to realize that I was in the right place. Each activity responded directly or indirectly to patients’ needs and gave preferential options to the poor and vulnerable. Seeing a strong system or a patient smiling, being exposed to robust capacity building opportunities—these all brought a satisfaction that I think I share with many colleagues at IMB.

I consider capacity building as part of accompaniment. Many patients have become health care workers. A great number of adolescents infected or affected by HIV have managed to get university degrees. A number of staff have received formal or ad hoc training opportunities.

Like many colleagues, I have received extensive training opportunities that have led to great changes in my career. Completing two master’s degrees and becoming a Ph.D. candidate was not random. It is rather a product of a strong mentorship system that IMB established. I started from scratch in research and scientific communication. The first draft of my first research paper was far from publishable. I always hide my first drafts but use them to measure the change. This was an area that makes IMB a unique site in staff development. My current priority is now to enjoy transferring that capacity to my colleagues.

This letter is dedicated to Toni Habinshuti, Felix Cyamatare, Neil Gupta, and all executive members working tirelessly to keep IMB a best performing environment. I send my humble gratitude to my mentors, mentees, and colleagues who not only believe in IMB but also apply its philosophy and core values in every interaction.

Happy Anniversary.

 

Andre Ndabarasa
Transportation coordinator

When I joined IMB in 2006, Rwinkwavu was all bushes, a dirt road, and only two PIH cars despite having so many patients and a number of activities that required cars. Transport-wise, it wasn’t easy to coordinate, as there was a high demand for the cars. They were used for all types of activities, including working as ambulances for patients.

The living conditions in Rwinkwavu were terrible. There were no shops, no markets, and transportation was also a big challenge. It was hard to meet basic needs since it was one of the poorest rural areas. On my first day, I had to walk 12 miles on a dirt road to reach IMB.

As the number of staff has increased, so have the living quarters in the area. We started to see development and infrastructure improve too. Three more cars were bought to meet the demand and an ambulance was donated.

I would spend three weeks without going home because of the heavy workload. I remember once staying awake for three days and nights, taking patients between hospitals and picking up emergency cases. I would use the ambulance at night, and deal with other transport issues during the day.

What has motivated me to stay with IMB all these years is the fact that IMB’s work directly impacts local and vulnerable Rwandans. The lives of vulnerable people are transformed for the better. IMB helps people to help themselves. It supports them and teaches them to be self-reliant. I am glad to be working with an organization that goes to the needy and brings positive change to thousands of lives.

I have a lot to celebrate since joining IMB. I can now speak English confidently, which I learned from IMB, and I can now use a computer and do some of my work on a computer. I am also motivated by the fact that IMB recognizes my hard work and dedication and rewards me for it. PIH is a family to me now.

 

Cyprien Safari
Medical stock coordinator     

Having worked with IMB since 2005, I am celebrating my own 10 years with IMB alongside IMB’s 10th anniversary. I started as a nurse, but today I am the medical stock coordinator.

I came from a poverty-stricken village that was full of despair. My father died right after I joined IMB, but I found hope at IMB and have never looked back since.

When I joined IMB, Rwinkwavu was a deserted place. There were many sick people who had given up seeking medical care since there were no health facilities in the vicinity. Many of them were only waiting to die—although they looked like they were already dead. Rwinkwavu was a mess.

IMB came and restored hope and health in Rwinkwavu. IMB health workers would go find the sick people in their homes, take them to the health facility, and offer them treatment. People thought they would never heal, but they regained their health.

Many in Rwinkwavu and the neighboring areas now have proper health care, the likes of which they never had before.

I have also had a chance to benefit from different trainings under IMB. They have enhanced my career with trainings in pharmacy management, supply chain, quality improvement, human resource management, and health services management, among others.

The leadership team at IMB served passionately while reaching out to the sick people and meeting their needs. My motto is “whatever it takes.” I have learned from IMB to do whatever it takes in order to save lives and restore health. This is the spirit one sees at IMB. Leadership and staff serve passionately, playing a role to improve people’s lives.

Seeing how IMB has transformed many lives—not only through offering treatment but also through improving their general socio-economic wellbeing—has kept me going. This has kept me glued to IMB since its inception. It isn’t about the money. It’s about the changing of lives that are on the verge of death.

 

Jean Claude Gatoto Rutayisire
Head supervisor of community health

I was one of the very first employees and patients of IMB, when it was established 10 years ago in Rwinkwavu. I was already a resident of Rwinkwavu so IMB found me there. I was working with HIV associations then.

When IMB started in Rwinkwavu, I joined as a volunteer, and also as a patient, since I was living with HIV.

There was only one health center and no hospital in the area. There were no doctors and fewer than five nurses. IMB focused a lot on HIV. Many people were living with HIV, but were ignorant; they thought it was witchcraft.

As a volunteer, I helped create awareness of HIV and show IMB where the sick people were. I worked with the sick and encouraged them to seek medical care, as the majority didn’t know it was important. Rwinkwavu was one of the poorest and most rural areas in the country. Most people were ignorant about diseases and how vital medical care is. As time went on, more people were enrolled as community health workers. They would travel within the community under the supervision of IMB, monitoring patients’ health and following-up on patients who were on daily medication. Later on, three doctors joined the team and more people began seeking medical care from the health facility.

IMB gave more than medication, providing food and transport and building houses for the sick and poor patients. The organization also started getting community health insurance for patients.

Personally, IMB helped me overcome stigma. Many of the people I used to work with rejected me and stigmatized me because I was HIV-positive. IMB helped me to start living positively. Most people used to say I would never have children of my own because I was infected, but now I have five children.

I wasn’t doing well then but IMB helped improve my livelihood and employed me. My salary has increased. I used to live in a one-room house with my family, but today I am a proud owner of a big family house.

My biggest dream is to complete high school and even pursue further studies. I hope that IMB can help me fulfill this wish. I also hope to visit Haiti and Boston to share work experience with colleagues at those sites.

After 10 years, the biggest thing to celebrate is that IMB improved the livelihoods of many people in many communities.

 

Peter Niyigena
Community health director

Known as “Nurse Peter” throughout the IMB community, I am celebrating a decade with IMB this July. Currently finishing my master’s degree in environmental health, I joined IMB during its inception, working as a ward nurse at the health center, which was the only health facility in Rwinkwavu.

Rwinkwavu was a total mess in terms of health facilities. The only health center available had about three nurses and offered very few medical services, but the need was high. People had given up on seeking health care despite being sick; this is because they knew that there were no medics or treatment available. However, the story changed when IMB was established in Rwinkwavu.

IMB expanded health services, bringing treatment and more trained medics. We then went to the communities to inform people about the services the health center was providing. People started seeking treatment. Health services were expanded, including maternity services, HIV care, internal medicine, and a bigger laboratory.

IMB was different from the other nongovernmental organizations (NGO) in the district. Only IMB staff remained in the area to stay close to the vulnerable people it reached out to. IMB went where the sick people were and stayed there, while other NGO leaders and staff would return to the city.

So many people were dying from HIV/AIDS and tuberculosis. Most of those with HIV/AIDS had a very low CD4 count and were very ill as they had no access to antiretrovirals. IMB freely provided ARVs to the HIV-infected poor people, and even followed up to make sure they took the medication as prescribed. I was touched by this kindness and dedication to the poor and vulnerable. They provided food, transport, and lots of other social-justice measures alongside treatment.

These gestures tremendously improved peoples’ health and lives. This one of the reasons that I have stayed with IMB for the last 10 years: being a witness to lives transformed every day.

Through working with community health workers, thousands of people in the community are reached every day, offered treatment, invited to learn about health, and encouraged to visit health facilities.

Overall, if IMB hadn’t been established in Rwinkwavu, many people would have lost their lives. I have seen many people who were in a critical condition 10 years ago; IMB came to their rescue and today they are still alive, happy and healthy!