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I wasn’t sure what to expect when I arrived at Mahamodara Maternity Hospital. The tuk tuk dropped us off outside of what appeared to be fortress walls. We were met by our Duke coordinator and led through the gate, past a building that was in disrepair and dilapidated. We traversed through a labyrinth of crumbling plaster and boarded up windows. There was a smell of mildew lingering in the air. I thought to myself, “Women come here to give birth”? Once we rounded a corner, I noticed an area to my right which looked as if it should have been full of expectant women, but was eerily vacant. It was then I realized what I was seeing was the shell of the Mahamodara which stood during the 2004 tsunami. I stared into the ward, and could imagine this area full of pregnant women and newborns on that day, and could almost feel their terror. I was told the hospital was hit by 3 waves. The first wave destroyed the “fortress” walls that I had seen earlier, but these barriers had lessened the impact to the building. It flooded the first level and knocked out the electricity. The doctors and staff evacuated the mothers and infants, some to higher ground, and others to Karapitiya Hospital. The second wave was estimated between 20-30 feet high. There are many stories of heroic men and women from that day, including one physician who calmly completed a Cesarean section by flashlight after the first wave hit. He then safely evacuated the mother and child. Due to lack of funds to demolish the building, it now stands as a temporary memorial.

We moved on, and at the end of the hallway we entered a courtyard. In front of us was a beautiful new building which now housed high risk expectant mothers. The ward contained 64 mothers who had a variety of problems, such as gestational diabetes, hypertension, and preterm premature rupture of membranes. There were strict visiting hours here, so there were no hovering families or concerned husbands. The hospital has very few fetal heart rate monitors, so the midwives and nurses monitor the fetus through the use of a pinard.  I spent a lot of time in this ward, and in the antenatal clinic, examining patients. I practiced with the pinard, straining to hear the fetal heartbeat as clearly as these experienced midwives, who could easily estimate fetal heart rates. I did many abdominal examinations, measuring the fundus, palpating the fetal position, and attempting to guess the baby’s weight in kilograms. I was certainly attaining one goal I had for this rotation, to get back to basics!

I witnessed the miracle of birth for the first time this week. I made my way through the maze of exterior hallways at Mahamodara to the labor and delivery room. Once I entered, I saw 10 wrought iron beds sitting side by side, each containing a woman in varying stages of labor. Two had just given birth and were coddling their newborns, encouraging them to breast feed for the first time. Several were in the final stages of labor. I chose a mother and joined the midwife and medical student who were at her side. I again noted the palpable absence of the typical “cheering squad” you see in America. These women were left to hold their own legs, and labor alone. There are no epidurals or pain medication, just pure will and true grit. After another hour of exhausting effort, she gave birth to a healthy baby girl. A new mother’s joy transcends all language barriers!

This was my final week in Sri Lanka. I cannot express enough gratitude to the doctors and staff at Karapitiya Hospital, and the University of Ruhuna Faculty of Medicine, for all of their time and willingness to share their vast knowledge.  The long journey home gave me time to reflect on my experiences here, and all that I have learned. Of course I am extremely grateful to have had the opportunities to assist in surgeries and delivering babies, to learn about rare illnesses not seen in the United States, and to practice primitive examination skills; but some of the most invaluable lessons I have learned were from the Sri Lankan people themselves. They are a hopeful people. Having recently suffered through a natural disaster, as well as a three-decade long civil war, they see brighter days ahead and are working hard to be sure the whole world can see them too. They are patient people, accepting of the fact they may have to return to the hospital daily in hopes of being admitted, or that their surgery may be delayed by many weeks. They are people who are full of grace, willing to undergo painful procedures without pain medication or anesthesia, with no complaints. Finally, they are a grateful people. They understand they are fortunate to have free healthcare and very skilled physicians. The phrase “medical malpractice” is foreign to them, and litigation against their physicians is unheard of. They are grateful for visitors from faraway lands and are eager to share their history and culture with all those who are willing to make the trip!

January 13

I can’t believe my time here in Haiti is over—but it is. I’m writing this from my guesthouse in Port-au-Prince, in preparation for my flight home tomorrow.

I would like to thank Senator Frist for forming the Frist Global Health Leadership Program, and for allowing me to have come to Haiti to work at HIC. I’d also like to thank the many people at Vanderbilt, Dartmouth, and HIC who helped me make the needed connections and organize the details of my trip. Last but not least, I’d like to give a special shout-out to my boyfriend, for supporting and encouraging me to leave him—and the U.S.—for three months and go work in Haiti. Thank you.

Although there were certainly nights that were incredibly difficult, there were many more that were amazing, and I am so very thankful for having been able to work at HIC. I was able to learn from so many experienced, kind, patient doctors and (mainly) nurses. They opened their hospital and the maternity ward to me, and were willing to teach me and make me an infinitely better midwife. I know that my time at HIC will forever impact how I care for my patients, and how I look upon all of the resources available to my moms and babies back in the U.S. Additionally, working here has further solidified my desire to work internationally, and has given me a clearer idea of what that life will be like.

I sincerely hope that if Senator Frist had come to visit HIC that the staff and the patients I interacted with would have said I was worthy of being a Frist Leader.

This last picture is of me and an auxiliary nurse (kind of like an LPN) named Mrs. Lorcey. Mrs. Lorcey works most nights, and so I worked with her more than any other provider during my time at HIC. I was always pleased when I'd arrive to work and see Mrs. Lorcey there because we worked well together and respected each others skills as providers. Although at first Mrs. Lorcey didn't trust me--as she shouldn't have--as I slowly proved myself and my skills she let me do more and more on my own, and helped guide me through interventions that I'd never done/seen before. By the end of my time at HIC I know that she believed in my abilities, and let me work as independently as I wanted. I worked with Mrs. Lorcey on my last night at the maternity and in the morning when it was time to leave she gave me a big hug--something I didn't see that often in Haiti--and told me she'd miss me. I will certainly miss her,  her smile and her quiet, calm encouragement when I was stressed or unsure of what I was doing.

 

 

Senator Frist's new USAID video on family planning—the healthy timing and spacing of pregnancy—is a great, concise explanation of the problems centered around maternal mortality and what we can do to help, because we know it works. Take 1 minute and 52 seconds to watch it. It'll be worth your time.

I’ve been home from Rwanda and Kenya only a few days and I’m already on another flight, heading back to Aspen, this time for the Aspen Ideas Festival Spotlight: Health, co-sponsored by the Robert Wood Johnson Foundation.

It’s on flights that I have time to reflect on a few takeaways, drawn from the myriad impressions and experiences I gathered in Rwanda. I tell everyone that journeys to Africa are life-changing and indeed this one was for me, and hopefully those who joined me.

  • Partners in Health—that unique Boston-based nonprofit global health organization—is uniquely positioned in Rwanda to develop research-based health service models that can be applied around the world. In fact, we in the States have much to learn from these. It’s well on its way to doing innovative, PROVEN programs of science-based health delivery; creating disciplined training programs; and even taking aggressive cancer therapy to the rural poor in a way that is economical and effective.
  • Paul Farmer should get the Nobel Prize. He has demonstrated in Haiti and Rwanda and around the worldthat health care can be brought to the people who need it. He has shown the world that therapy once regarded as too expensive to buy and deliver—like HIV treatment—can be effectively and inexpensively administered to the poor and rural. And now he is addressing cancer treatment in rural Rwanda.
  • Gorilla health is like human health. My work with the gorilla health began at the National Zoo in Washington. Some mornings I would scrub in at 6 am over in Rock Creek Park to take care of a sick gorilla before opening the Senate as Majority Leader. My interest in gorilla health continues, and that is why I introduced our group at the base of the Virunga Mountains to the vets with the Mountain Gorilla Veterinary Project, on whose board I served for years. The upland gorilla, whose march toward extinction was reversed by Dian Fossey, has grown in number from 750 to 880 just over the years I have been involved. Animal conservation working hand in hand with animal health makes a difference. As an aside, I want to raise a red flag to the rapidly growing problem throughout Africa of elephants being massacred for ivory.
  • ONE health is a concept and a movement I hope others come to understand. It gives name to my conviction of focusing time and energies on human health, animal health, and environmental health. Health and healing applies to all—in Rwanda to the land around us, the farmers, the cows and buffalo, all interacting integrally with each other, as so clearly manifested at the base of the Virunga Mountains. Living side by side with mutual respect for each is the only answer. Gorillas are extremely susceptible to human-borne illness. Crowding brings buffalo in close contact with the gorillas, contaminating waterholes and leading to disease and death. Too many people still rely on bush meat for food, killing gorilla and monkeys. Gorillas are also threatened by hunters trying to trap antelopes for holidays and celebrations, unintentionally ensnaring baby gorillas. Health for one is health for all.
  • The HRH program in Kigali blew me away. It will work and I predict become the model of the future where governments are not corrupt. It is built around partnerships. Twenty-six US universities partner with USAID, the source of $33 million, to deliver and improve health services in Rwanda. The process through which the money flows goes like this: the American taxpayer gives his money to USAID who channels the money to government of Rwanda led by Paul Kagame who channels the money through the highly respected Minister of Health Dr. Agnes Binagwaho. Dr. Binagwaho distributes the money to the sites; 86 health professionals on the ground lead large programs to improve health service delivery. An orthopedic surgeon from the Brigham in Boston or a hospital administrator from Yale may then come to introduce systems to the Rwandan hospitals and district pharmaceutical distribution center. Over an eight year period, the goal is to train Rwandan workers with the skills and knowledge to build and sustain their own programs over years to come. It is working and it is a wise and smart use of the taxpayers’ dollars.
  • Paul Kagame is the man for the times. He has courageously taken a country that in 1994 was deeply divided by genocide, which claimed the lives of 20% of the population, and deeply divided by artificial colonial convictions, and though strong leadership has reconciled the people, formally achieving forgiveness in the immediate aftermath of neighbor-killing-neighbor, and establishing and maintaining remarkable peace. At the same time his belief in markets and investment has led to 29 years of annualized growth of 8% and is greatly expanding the middle class. His leadership is dramatic. He leads from above but implementation begins at the village level. When the president says thatched grass roofs lead to poor health and suggests replacement, it is each neighborhood that comes together every Friday over a two year period to assist in replacing the grass roofs with metal ones. When it is identified that wearing no shoes, the African custom, allows parasites to enter the body leading to disability and death, a proclamation from above to wear shoes was implemented at the community level almost immediately. The New York Times and New Yorker don’t like him, but I think he is an amazing man who has saved his country of 11 million people.
  • Journeys to Africa by Americans are a good thing. Our group of 10, half of whom had not been to Africa, bonded and shared our own perspectives in a close, personal, and intimate way. Africa touches one’s heart. It inspires. It cause one to dream. It changes your life.
  • Health care is improving fast in Rwanda. Vaccinations far surpass those in the US. Childhood mortality has been cut by 2/3. The basic district health clinics are accessible to all and they place a heavy emphasis on family planning, healthy pregnancies, and early childhood health and nutritionMaternal, newborn, and child health are the foundations of strong communities. The fledgling national health insurance system is solid and growing fast and has been received well. The system gets by with MRIs and CT scanners. It has only one urologist in the country and five pathologists. Heart surgery is rarely done. But all that will change as the economy improves. The new cancer center at Butero, established at the district hospital as a brainchild of Paul Farmer and the Ministry of Health, will greatly expand cancer therapy the county, heretofore lost in all of the attention on infectious or communicable diseases like HIV, malaria, and tuberculosis.
  • On my return journey, I stopped in Nairobi, Kenya. Crime in Nairobi is high—street crime and home invasions with burglary and carjacking. Al-Shabaab, the al-Qaeda-affiliated Somali terrorist group, is increasingly threatening the city. Tourists are not coming and hotel census is down. Corruption rules the government and police, it seems. But commerce continues and I spent a day in a wonderful market and had top notch service at the Tribe Hotel, where Jonathan, my son, introduced me to the wonderful family who has developed it.

Originally published at The Hill

When parents in America think about their children turning five, sending them off to kindergarten for the first time can be stressful. But if you live in the developing world, your biggest worry is whether your children will even live to see their fifth birthday.

But that is changing, and this year six million fewer children will die before their 5th birthday than in 1990.  To put that in perspective, that’s 2 million more children than are even in kindergarten in America today.  Driving that change is an unparalleled reduction in deaths and sickness from pneumonia, diarrhea, measles, HIV/AIDS, malaria, polio and neglected tropical diseases.

This is a global sea change, and if it surprises you, you are not alone. Relatively few Americans are aware of this remarkable story, much less the role the United States and many other global actors played in making it happen.

Americans can be proud that these unprecedented advances would not have happened without our involvement as the largest single donor to global health and working in historic collaboration with the other governments, multilateral institutions, local entities, NGOs, civic groups, faith and business communities, universities and philanthropies.

As the majority and minority leaders of the Senate in 2003 when the President’s Emergency Plan for AIDS Relief, or PEPFAR, was created, we know firsthand how pivotal the U.S. role was in one of the biggest pieces of the global health puzzle.

Through PEPFAR – which President George W. Bush initiated with vision and strength, and President Obama has worked hard to continue – the U.S. led the international community by providing tens of billions of dollars to stop the spread of HIV, giving appropriate care to the millions ravaged by AIDS and keeping them alive with anti-retroviral and other interventions.

PEPFAR is one of the crowning examples of how American resolve and leadership can bring about an enormous impact with a relatively small portion of our national budget. It shows that Democrats and Republicans can actually agree on historic health initiatives, not only on HIV/AIDS, but also in tackling malaria, vaccines, clean water and other smart and effective interventions. That same collaboration of compassion can continue to save millions of lives in the future.   

The improved child survival rates are so startling they are hard to believe at first glance. According to a 2013 UNICEF report, the global mortality rate of children under five years old dropped by 47 percent, from 90 deaths per 1,000 live births in 1990 to 48 per 1,000 in 2012. In some regions, the decline in under-five mortality was even steeper– as high as 65 percent in both the East Asia and Pacific and the Latin America and Caribbean regions.

A large portion of the progress came in much of the last decade, not coincidentally after the historic international commitment to the Millennium Development Goals. UNICEF estimates that, as compared to 12 years ago, today 700,000 fewer children die of pneumonia, and 600,000 fewer children die of measles.

Not only did deaths decline, so did sicknesses. Polio cases have decreased by more than 99 percent since 1988, when the disease was endemic in 125 countries. Today, polio is in only three countries. That is nearly all-out eradication of a dreaded malady that it seemed would never go away.

Encouraged as we all should be about the successes so far, there remain 6.6 million children under five who will not reach their fifth birthdays this year, dying mainly from preventable diseases. That is just not acceptable. Without a similar commitment by the U.S. and other international partners in the foreseeable future, we risk squandering the gains of the last 25 years and missing the opportunity to go even further in the next 25. We must keep driving the momentum that got global health to this point.

Some worry the commitment could wane, as Congress has struggled of late to achieve bipartisan consensus on much of anything and, according to a recent Pew Research Center study, a majority of Americans prefer to limit our international engagement to take care of problems at home.

Based on our experience with PEPFAR and other global health initiatives, we are convinced members of Congress from both sides of the aisle remain united around the small, but smart, investments in global health that have historically yielded extraordinary results.

And this week, businesses, NGO, faith, civic and philanthropic leaders are increasing their own investments, coming together to affirm their commitments of more than $2 billion of private resources to invest in ensuring children survive and thrive beyond their fifth birthday.

The world knows what works to increase child survival rates, and we can do this.  But doing it will require continue bipartisan cooperation and the energetic grassroots efforts that made the last 25 years of progress possible.

Daschle served South Dakota in the U.S. Senate from 1987 to 2005 and was the Majority Leader from 2001 to 2003. Frist served Tennessee in the U.S. Senate from 1995 to 2007 and was Majority Leader from 2003 to 2007.

January 5

Happy New Year!

Apart from working at the maternity this week—and getting to celebrate the arrival of 2013 with laboring women and their new babies—I’ve been busy completing the list of HIV+ women who have been lost to follow-up.  From March of 2009 until November of 2012 there were 240 women who started receiving HIV care at HIC, but now no longer are doing so. I really hope that the social worker and the community health workers will make use of this list and that some of them will be found and restarted with their HIV care. I am however, not incredibly optimistic that many women will be located. The social worker and community health workers are already very busy and to try to track down 240 women—with little more than their names, dates of birth, and possible addresses—seems very ambitious. But I feel that if even one or two women are found and are restarted in care that my work on the list was worth it. 

Along with the lost to follow-up list I’ve also been working on an “opposite” list—collecting information about those women who are still receiving HIV care at HIC. The hope is that with both lists, providers at HIC will have a better sense of whether or not there are differences between those women who are lost to follow-up (LTF) and those who are active. Maybe it’s the timing of enrollment in the HIV program, or whether or not a woman gives birth at home or in the hospital, or her age that is a significant factor in whether or not she stays in care. With that information the providers at HIC may be able to modify certain aspects of their program (i.e. enrolling women earlier if that was shown to make a difference) or focus on certain “at risk” women (i.e. if older age is show to have increased LTF risk, providing more education/support to those in that age range), thus—hopefully—decreasing the programs LTF rate and ensuring more women (and their babies) receive the important HIV medication and care.

This week I also went into the capital and had the pleasure of meeting a woman who is running GHESKIO’s Nurse Practitioner program. (GHESKIO stands for the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections, and was the first institution in the world dedicated to the fight against HIV/AIDS. It has provided continuous free medical care in Haiti since 1982) I talked to her about what can be done to better define the role of an NP in Haiti—to distinguish NPs from the nurses and doctors, and to make sure that the doctors don’t worry about NPs “taking their jobs”. I also got to meet three women who have already graduated from GHESKIO’s NP program who are working as NPs at GHESKIO. All of the women that I met were amazing. They were all very motivated and open to improving the NP program and striving to provide the best care they possibly can for their patients. 

 

*I’m in Rwanda this week representing Hope Through Healing Hands with Dr. Paul Farmer, Partners in Health Rwanda, and Harvard Medical School. These dispatches from the road are my personal journal–recording what I’ve seen and learned on this trip. See my pre-trip thoughts, and blogs from MondayTuesday, and Wednesday

Today we went to see some of Rwanda’s natural treasures: mountain gorillas.

Rwanda has a long history of gorilla conservation. Dian Fossey, author of Gorillas in the Mist, founded the Karisoke Research Center in Rwanda in 1967 and studied gorillas in the Virunga Volcanoes until her death in 1985.

We were hosted by Gorilla Doctors, a mountain gorilla veterinary project supported by the UC Davis Wildlife Health Center and dedicated to saving the mountain gorilla species one gorilla patient at a time. Gorilla Doctors serve the mountain gorillas throughout the Virunga Volcano Mountain Range that spans Uganda, Rwanda, and the Democratic Republic of Congo (DRC).

With Gorilla Doctor guides, we spent six rainy hours trekking through Volcanoes National Park looking for the Titus family of 10 gorillas—including one silverback and one 3 month old newborn. We finally caught up with them at about 9,000 feet.

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These incredible creatures are monogamous vegetarians. Each mother has 4-5 children during her lifetime, starting when she’s about eight years old. They can live to be 43 years.

At one point, the gorilla population here was down to 250 animals. When I visited in 2008, there were 750. Today, Gorilla Doctors estimates that there are 880 gorillas.

But gorillas are not quite the departure from human health that they may seem.

Dr. Jan Ramer, regional manager of the Mountain Gorilla Veterinary Project, explained that Gorilla Doctors approach their work from the “one health” perspective, a belief that the health of one species is inextricably linked to that of its entire ecosystem, including humans and other animal species.

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It’s easy to see how closely the species connect.

The number one killer of gorillas is trauma. On our walk we came across three rope and wire snares. Though meant for antelope, gorillas, especially infants and juveniles, sometimes get caught in these snares. Gorillas may lose limbs or digits to snares, or die as a result of infection or strangulation. Gorilla Doctors respond to reports of gorillas in snares and work to treat their wounds and release them.

The number two killer of gorillas is infectious diseases, and humans and gorillas are susceptible to the same diseases. In fact, the most common infection in gorillas is respiratory disease, which can range from a mild cold to severe pneumonia, in individuals or in whole groups. These diseases are often passed from human to gorilla.

I’ve worked with these animals before, even doing some gorilla surgery, but seeing them in their homes never gets old. Amazing creatures.

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December 28

As I mentioned in my last post I’ve struggled with practicing as I’ve been taught and believe is best while also trying to respect how my Haitian counterparts were taught and what they believe is best practice.

There was a woman who came in in labor this week and when the doctor examined her he said that she would need an episiotomy (cutting the perineum to make the vaginal opening bigger) in order to give birth (this was long before the baby was even close to being at the perineum when something like that could really be evaluated). I had labored for most of the evening with this woman and thought of her as “my patient,” and was more than a bit frustrated at the prospects of her having an episiotomy. I told the nurses I was working with that I didn’t think she needed an episiotomy—and explained that in the U.S. the literature shows repairing lacerations is better than repairing episiotomies—and that if I caught her baby I wasn’t going to perform one. Needless to say, I was not allowed to catch the baby and she got an episiotomy (and actually had quite severe post-partum bleeding, I believe in part as a result of her episiotomy).

I know that the nurses where just doing what the doctor ordered them to do (as is appropriate), and that they believed that performing an episiotomy was best practice, but it was still very hard for me to watch. I however, see no easy way to reconcile our differences in practice. Although I’ve tried to talk to the nurses about why we in the U.S. don’t perform episiotomies (and various other practices), at least in this type of society behavior change needs to come from the top (i.e. the OB/GYN chief) and not the bottom (i.e. night nurses). And although I feel very strongly about the issue I’m reticent to go to the head of the OB/GYN department and try to lobby for such a change. Part of that that is me being scared and non-confrontational, but it’s also hard given that this is what is believed to be best practice and still taught in the medical/nursing schools, and I’m “just” a visiting foreign new midwife lucky enough to have been allowed to work at HIC for these 2.5 months. So, I’ve done nothing—except never perform an episiotomy and have had many moms with no lacerations (when I was told an episiotomy would be needed) or well repaired ones. I know that’s not enough and that I’m not serving my patients as best I can, but it’s all I feel comfortable with doing at this point. 

*I’m in Rwanda this week representing Hope Through Healing Hands with Dr. Paul Farmer, Partners in Health Rwanda, and Harvard Medical School. These dispatches from the road are my personal journal–recording what I’ve seen and learned on this trip. See my pre-trip thoughtsMonday’s blog, and Tuesday’s notes.

This morning we met with patients and physicians at Centre Hospitalier Universitaire de Kigali (CHUK), the urban hospital equivalent. For the past few days we have explored Paul Farmer’s vision of taking health care to the people in rural areas, so often neglected around the world.  Today we looked at health care in the city.

CHUK is the primary teaching hospital, located in the heart of Kigali. With 25 departments—17 clinical and 8 administrative—CHUK provides training, clinical research, and technical support to Rwanda’s 39 district hospitals.

Again we were able to meet patients and hospital staff. I was particularly impressed with this three-year-old little firecracker. He fractured his hip falling out of tree, but that wasn’t keeping him down! I also had the honor of meeting this dedicated woman. She’s served as a nurse in all of CHUK’s departments over the past 11 years.

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Over and over I’m impressed with how much Rwanda, with PIH and other groups, has accomplished.

For instance, Rwanda has one of the highest vaccination rates in the world—a status they have achieved through very hard work over the past eight years.

Vaccines for children here are a series of six individual vaccines that begin at birth over the first two years of life. In a country with about 11.5 million people—the majority of whom are very poor, a 94% vaccination rate has been achieved through national campaigns centered in communities. The vaccines are administered through community health centers in each of the villages. This is really, truly remarkable.

Breast and cervical cancer have been on the rise in Rwanda, so in 2010, a national campaign to vaccinate schoolgirls against HPV began that is gradually making it across the country through community health centers. The hospital at Butaro—where we were yesterday—is participating in research and the collection of data around this vaccine.

It works; it’s a great vaccine. For cervical cancer it’s very important. And Rwanda is taking a leadership role. As you can imagine, cancer is not treated well in the developing parts of the world. So it’s pretty remarkable that both a vaccine program and cancer care are coming together here.

Of course Rwanda’s remarkable progress is contrasted by the genocide that took place here 20 years ago.

This afternoon we visited the moving Kigali Genocide Memorial, where the history of genocide worldwide is powerfully presented. It was a return visit for me, but no less humbling.

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Last time I was here, a bipartisan group of Senators laid a memorial wreath. This time, I considered what Rwanda has accomplished in those 20 years:

  • a dedicated nurse spending 11 years caring for the sick;
  • Partners in Health Rwanda’s work over the past nine years;
  • a nationwide vaccine program against polio, tuberculosis, and measles, for the past eight years; and
  • the PIH Women’s and Girls Initiative training women for the past six years.

But these are only the beginning.

Maybe the most hopeful thing I saw today was the work of Human Resources for Health (HRH). We had the privilege of meeting physicians from this innovative Rwanda-U.S. joint partnership to strengthen the Rwandan health care system.

Harvard Medical School, USAID and other US government programs are funding about 70 to 100 clinicians and administrators and planners through the Rwandan Ministry of Health to develop the clinical service infrastructure.

These are inspiring mid-career physicians from Harvard-affiliated hospitals who are changing the world. Our tour was conducted by an American orthopedic surgeon who is dedicating a period of her life to serving the hospital and the training program of young Rwandan physicians.  They are all heroes.

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The program, funded by the American Taxpayer and in its second year of an eight year commitment, is a tremendously powerful and smart investment in the future.

What is needed in Rwanda—and globally!—is a long term plan. HRH is building up infrastructure which is so badly needed to lift up the health sector here. But equally importantly, their work will make health care in Rwanda sustainable and prepared for the future.

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