It’s been 6 months since I was in Kigali (a herniated disc got in the way of a scheduled trip last October). There are some noticeable changes. Houses (and the people who used to live in them) have been cleared from certain areas to build hotels and more expensive housing. Too many cars are leaving the air visibly smoggy. Food costs have doubled and families struggle to eat one solid meal a day. In terms of the military situation with the Congo, our friends here say that they feel safer knowing there is more stability and control of the situation, with Rwandan soldiers there, but it is costly. When asked about members of the Hutu Interhamwe militia returning from the Congo to Rwanda now and going unpunished, they say they have been living with this kind of situation all along. Some say that in their minds they trust the soldiers will keep things safe, but in their hearts they feel uncertain and anxious.
Bustling WE-ACTx House
The WE-ACTx house was bustling when I arrived a couple of weeks ago with volunteers, interns, and colleagues working on many different projects—cervical cancer prevention, yoga, Cognitive Behavior Therapy training to name a few. A crew of gynecologists from Montefiore was training nurses to perform VIA (visualization, inspection with acetic acid). This is a low tech screening method for detecting cervical abnormalities and then treating on the spot with cryotherapy. WE-ACTx became interested in cervical cancer prevention years ago as we saw that Rwandan women were unscreened (no Pap smears were available then) and cervical cancer was the major cause of cancer death in women. Women with HIV also have a greater likelihood of cervical dysplasia. Watching the intensive hands-on training (first with plastic models, then with patients under close supervision) and the graduation ceremony was really incredible. Now 17 nurses have been trained in cervical cancer prevention and efforts to bring a full program here are continuing.
gynecologists from Montefiore provide training
Rwanda reports that over 60% of those needing antiretroviral medications (ARVs) are on them. This is amazing and much higher than most of the rest of sub-Sahara Africa, where uptake of ARVs is reported at ~ 25% (due to poor government will, stigma, discrimination, poverty, lack of available clinics and drugs, gender based violence, etc).
Yet, even with ARVs available for many in Rwanda, we find many obstacles. One 15 year old on ARVs in our clinic is about to start a secondary boarding school (with funds through a WE-ACTx program). He told the peer advocate that he doesn’t know how to bring and take his ARVs and still keep his HIV infection hidden from others. There is no school policy in Rwanda about who should be informed of students’ HIV status. The WE-ACTx trauma counselor then helped him find someone at the school to confide in, and to communicate with about future issues. Some students tell of making up stories about having other diseases to explain why they take medicines, so fellow students won’t find out they are HIV+. Interestingly, when WE-ACTx began the Family Program, few children were on ARVs, and fewer still were in high school. Now, children are doing so well on their medications, there is a demand (which WeACTx is trying to meet) for us to use some of our resources for school fees. If cases of discrimination and stigmatization arise among students from WE-ACTx, our legal program pursues various means to protect the youth.
the mothers group at Nyacyonga clinic
Also on the mostly-good-but-of-course-complicated-news front, is the mothers group at Nyacyonga clinic. Here 22 post partum women meet every 2 weeks with a WE-ACTx counselor to support each other; one remarkable need they must grapple with is how to deal with nursing these infants. They have all taken ARVs during their pregnancies and all have uninfected infants. Current recommendations here are for exclusive breast feeding up to 6 months (unless complete provision of formula feeding is feasible). Finding enough food for continued growth and development of the children after 6 months is not easy for these mothers and this has become part of the agenda of the support group as well.
A year ago, we began the Sosoma (combination of soy, sorghum and maize mixed with sugar and water) Program for all children on ARVs. WE-ACTx staff distributes enough daily porridge supplement for the child and 5 members of the family each month. Staff record the child’s weight and height from that month’s clinic visit for each registered child. About 120 children from 2-19 have gotten at least two months of Sosoma. Over 70% of them have gained weight. Another 20% have not gained weight, but some have gained height, and some have stable weights appropriate for their age (for example, some in the 17-19 age group). When we examined more closely the few who have lost weight, we found the majority were older youth who were doing well, and had minimal weight changes. Those younger children still losing weight were found to have tuberculosis (recently started on treatment) or had family psychosocial problems including alcoholism and abuse. TB, family discord, and using Sosoma as full nutritional support or for more than 6 people (food costs are so high here) are issues that require continued attention.
Volunteer Yoga Program
Our volunteer Yoga program has gotten off to a great start with yoga teachers scheduled through most of this year. Here, you can see Eunice Laurel with the children from the Sunday support group totally engaged. The children and INEZA sewing collective are particular avid yoga fans. Having support from our volunteers and all of you at such a difficult economic time is especially appreciated.
Thanks again,
Mardge
Women's Equity in Access to Care & Treatment