To Nicole Bronson’s delight, we gathered at the Hotel Gorillas this morning for reflection and snacks. It was our last full day in Rwanda so we started by going around the table and sharing our highs and lows of the trip. To name a few, we loved visiting the youth chapters and seeing their projects as a testament to how much young people can do when they’re given the tools; making new friends; Christmas at Jean d’Amour’s house; spending time with the FACE AIDS team; seeing the hospitals; meeting Paul Farmer; and spending time with kids. Low points in the trip were either not feeling well or feeling helpless in the presence of injustice, but we had Dramamine and overall we encountered more hopefulness than helplessness.

We spent the next few hours reflecting on the movement for global health equity. We talked about collective mobilization and what comes to mind when we hear the word movement, as well as what types of actions and tactics we think are necessary. It was fun and helpful to hear everyone’s thoughts. After a little break, we took different colored Post-It notes and wrote down thoughts in response to the questions: “Why do we need a movement for global health equity?” “How do we form a movement for global health equity?” and “What does our movement do?” We then posted our responses on pieces of paper corresponding to each question and read the rest of the group members’ responses to ourselves, putting a check mark on our favorites. For me, as a computer science major, it was the first time I’d thought strongly about wanting to be a part of this movement for global health. Being involved with FACE AIDS and especially being on this trip in Rwanda makes me feel like I can.

Cher-Wen showed us the video “How Not to Write About Africa.” After watching, we talked about stereotypes and generalizations of Africa, sharing reactions from friends and family when we told them we were traveling to Rwanda and discussing the misguided perception that Africa is a country and therefore homogenous. It reminded me of the first time I looked for Rwanda on a map. We can’t say we understand the entire continent of Africa now that we have spent two weeks in Rwanda, but we can work to dispel myths we know to be untrue.

Before an afternoon of souvenir hunting, we ate at a lunch buffet. (Earlier in the week, we learned that lunch buffets were government mandated for the sake of productivity!) After lunch we went to craft market and fabric markets to purchase bags, jewelry, art, key chains, figurines, and t-shirts for friends and family back home. The guys even found cool knives.

In the evening we met with Dr. Peter Drobac, the PIH Rwanda Country Director. We were originally going to have dinner with him last Wednesday, but he was stuck in meetings and now that I think about it that was another “low” mentioned at breakfast. But this timing was better in a way because we had more educated questions for him, plus we had coffee! He told us his story, and we asked about his work, the progress of health care in Rwanda, PIH’s relationship with the Rwandan government, and his hopes for the future. Peter was a psychology major in college and took a class about primates, which he enjoyed so much that he decided to go to Zambia the next semester to study monkeys. The monkeys got boring quickly but being in Zambia sparked his interest in global health care and he became a doctor even though he wasn’t originally pre-med. He read works by Paul Farmer and made the connection that Paul was as mad as he was about inequalities in health care. Peter worked with PIH during his residency and took the opportunity to move to Rwanda when the government first invited the organization in. He and the other doctors slept in the hospitals while they were still being constructed. I loved how much Peter loved his work—he even said he doesn’t mind working 14- to 18-hour days sometimes. He also had some great advice for us as students. Most importantly, he told us to do what we love and if we are passionate about global health care we will find a way to contribute using our talents. We don’t all have to be doctors to make a difference, especially if medicine is not what we are excited about. This movement needs everything from architects to business experts as well as physicians. Peter also said it helps to be a little angry about social injustices and health inequality. I think I can speak for everyone when I say that our time spent with Peter was an inspiring and awesome way to conclude the trip.

To round out the day, we shared Ethiopian food for dinner and packed a little before heading to bed.

Thanks for reading!

- Jordan Kellerstrass, Creighton University ‘14

After an early morning breakfast at Butaro Hospital, our group packed into a Partners In Health van and headed to visit a pygmy community living within Butaro Hospital’s catchment area. Prior to Rwanda’s progression past ethnic identities, these vulnerable communities were known as the Twa. During the genocide of 1994, many were killed and many others fled as refugees to other countries. There has been a history of heavy stigmatization against the pygmy communities, furthering their lack of socioeconomic integration into Rwandan society. Prior to our visit, we were informed of the destitute and almost unimaginable housing conditions that these individuals were living in before Partners In Health mobilized the community to construct new structures. Even with the words of caution, I was not sure what I would be witnessing. Reaching the village included a long, bumpy car ride on the side of a mountain. In addition to admiring the breathtaking view of Ugandan mountains and Rwandan valleys, I could not help but be amazed by how far residents of the area had to walk to obtain medical care. I tried to imagine myself as a sick person walking down a mountain to get to the nearest health center and then started hoping that a health post closer to the homes would be built soon.

Walking to the Village

Upon reaching the entrance of the village, we left our van for a trek on foot up to where the community used to live. I have to admit, every walk I’ve taken in Rwanda up to a village or through cassava fields has left me in awe of how people skillfully maneuver and utilize the steep terrain to their advantage. After reaching the older settlement, we met with community members who had lived in the area for a very long time. The group we visited included adults, children, and senior citizens. The community spokesperson was the oldest person there, the village “grandfather.” He spoke very briefly about the poor living conditions his community faced before and how grateful they were that PIH has intervened. When asked about hospital visitations, he mentioned that community members were now visiting the hospital whenever medical needs arose. In contrast to past educational disadvantages, children within this community were now attending school. As I gazed around, I saw cows and other livestock that PIH had provided for the families. Also, the local government has promised that they will try to obtain more land for them to farm. Because land ownership in Rwanda is a very contested and complicated matter land has been tough to come by for these communities, but the local authorities’ promise gives them hope.

One of the New Houses

Next, we made our way down to hill to visit the new housing PIH built with the community members. My honest first reaction was close to a jaw drop when I compared the sturdy new houses these people owned to their old dwellings, which often did not even protect them from rain. We only saw the houses from the outside, but each house included a main house complete with furniture, a separate kitchen building with the basic cooking equipment, and a separate toilet. The separate toilet hindered the spread of disease and maintained a hygienic way of living and in an effort to prevent the spread of smoke throughout one’s house the kitchen is also detached from the main house. This was proof to me that when PIH took on an initiative, they made sure it was done in the best way it could be. In totality, it was obvious both from the community members’ expressions and from the tangible work in front of our eyes that the Rwandan government and Partners In Health are working together to provide a preferential option for the poor.

-Dipika Gaur, New York University ‘14

You can read more about the Twa community housing project and PIH’s Program on Social and Economic Rights (POSER) in this month’s educational theme on Social and Economic Rights.

Today was an eventful day spent in Butaro, an area in northern Rwanda. We headed out in the morning along one of the most scenic routes in Rwanda. To echo the impressions of my peers, the hills contain every shade of green imaginable. Add to it the reds and yellows of the soil contrasted against the light blue of the sky and you have the makings of a truly breathtaking land.

We arrived at Butaro to be greeted by Kamanzi, the PIH District Project Manager, and Vincent, the Community Health Program Coordinator. Kamanzi gave our group a tour of Butaro Hospital, an enormous district hospital built by the Ministry of Health and Partners In Health that opened in January 2011. Notable points from our tour that caught my attention:

1. The intersection of design and development: MASS Design’s special elements included color-coded wards, Big Ass Fans (it’s the brand name), a nurses’ station at the center of every ward, UV lights, short walls to separate beds that also pump oxygen, ventilation systems, and careful selection of floor material, among many others. Each design element carries a specific, purposeful implication for the health of patients. It is creativity and innovation at its finest.

2. The role of collaboration in building human resources: Rwandan doctors send x-rays to their counterparts in Boston to confer about diagnoses, American doctors work in Butaro and build specialized medical knowledge and train Rwandan doctors. This fast exchange of ideas and knowledge is crucial for increasing the number and knowledge of Rwandan medical personnel.

3. The necessity to find an effective way to treat non-communicable diseases (NCDs): Communicable diseases have long overshadowed the burden of NCDs, which Butaro Hospital doctors are seeing many cases of. However, it is difficult to find a model to provide long-term care for patients who often can’t come to the health facility numerous times. Finding a way to extend the decentralized model of health care that Rwanda prides itself on to NCDs is a challenge for the future.

I think it is safe to say that Butaro Hospital impressed everyone in our group. Reading back over the entries of past Rwanda Student Leadership Trip participants, all cited a feeling of inspiration at the structure—a beautiful hospital by any standard. But what I think I’m most impressed by are the people and programs that make the hospital. In the afternoon, we made three home visits with Vincent to see the effects of the community health worker (CHW) program. Listening to men and women recount the journeys of their health and their interactions with the health system made me realize that Butaro Hospital, as beautiful as it may be, is impressive because it serves as the center of an entire system focused on the community and the people that need health care most. It is the patients, the CHWs, the doctors, the staff, the architects, the government officials, the PIH staff, and how they all interact with one another that make Butaro a model for how things can and should be.

As much as all of us were inspired by the presence of such a beautiful facility in a relatively remote area of Rwanda, I found myself thinking that this should not be our reaction. There should be a day when we visit this hospital and accept it as the norm instead of the rare gem that it is now. Until then, we know what we’re working towards.

-Joy Liu, Duke University ‘14

“Silent Partners”

The spirit of hospitality and community found yesterday on Christmas extended throughout the trip. At one point, Bosco asked Jordan and I if we would stay in Rwanda forever if we had the choice. We said that we would never leave, but we would miss our families. Bosco then replied that we would have no need to be homesick because his family was our family and our family his. Generosity such as this continued to make our group feel at home in this new country.

Today’s theme was partnership. We visited three unique partner organizations which each take a multi-sector approach to comprehensively address the barriers of accessing healthcare in Rwanda. Representatives from Clinton Health Access Initiative (CHAI), Population Services International (PSI), and Gardens for Health International (GHI) graciously met with our group to answer our questions about their work in Rwanda and collaboration with Partners In Health and the Ministry of Health. Each organization works as a “silent partner” with the Ministry of Health, as representatives from PSI mentioned, by implementing programs that address the Ministry’s vision and goals, as opposed to implementing the organization’s own agenda.

All three meetings were so interesting! First, we met with Christian from Clinton Health Access Iniative at a café near our hostel. Christian is a doctor by training and is working on a facility-level cost analysis of HIV/AIDS treatment in Rwanda for the Ministry of Health. Christian shared with us the three main expenses for health facilities in Rwanda: the expenses incurred during delivery, supporting community health workers, and pharmacy and supply chain management. Christian also discussed the importance of creating incentives for medical professionals in Rwanda, as there are currently less than 500 doctors in the country with a population of more than 11 million. This is a topic that came up multiple times throughout the trip, including during a conversation with PIH Country Director Peter Drobac.

Our next meeting of the day was with staff members of Population Services International, an organization that utilizes behavior change communication through social marketing. PSI markets affordable “behavior-changing” products such as birth control, mosquito nets, and water purification tablets to the general public through mass media and interpersonal communication. PSI works in collaboration with the government to distribute and promote these products. There are several PSI projects in Rwanda with four target populations: youth, members of the military, commercial sex workers, and men who have sex with men. PSI also provides voluntary counseling and testing services for these populations. It is truly amazing to see the impact collaboration and social marking have on creating accessibility to certain health-related products in Rwanda.

After lunch, we headed to Gardens for Health International where we met with a Global Health Corps Fellow named Aaron. Antiretroviral treatment is not fully effective without a balanced and nutritious diet, and GHI addresses this through food education and empowerment. Aaron gave us a tour of the gardens and discussed the impact the organization has in the community. One interesting component of GHI is the awareness of the relationship between malnutrition and mental health. This is not something that I had often thought about, but Aaron mentioned that malnutrition in the womb can lead to mental health issues. We concluded this conversation about GHI’s work in Rwanda with some fresh guacamole and pita bread overlooking the land of a thousand hills. What an amazing day!

Seedlings growing at GHI

The main thread across these meetings is the importance of partnerships, especially with the government. It is through silent partnerships, such as those modeled by Clinton Health Access Initiative, Population Services International, Gardens for Health International, and especially Partners In Health, that all aspects of healthcare delivery will be made more dignified and accessible to the most vulnerable populations.

-Amelia Angevine, Clark University ‘13 (second from the left!)

Today we celebrated Christmas in Kigali! In the morning, we had a gift exchange and brunch at Bourbon Café. Some trip members also attended a church service with a doctor from Butaro Hospital.

Julie and her Golden Gate Bridge pencil sharpener from Laura

St. Etienne Anglican Church

Later that afternoon, Jean d’Amour kindly invited us to his home to celebrate Christmas with his friends. The Christmas party started out as a very formal meeting with introductions and speeches, but quickly turned into a dance party! This group of people who had met each other just one hour before came together to celebrate Christmas with singing and dancing like one big family.

Speeches to Dancing

It was surely one of the most memorable Christmases for everyone on the trip!

Joy and I had a wonderful wake up call of Rwandan Christmas carols from our host family’s radio. Almost time for Christmas in Kigali! We sat down for breakfast with Innocent, the head of both our host family and the Rwandarera cooperative. We had piping hot African coffee from Innocent’s own cow that he was able to purchase because of the cooperative’s successes. Soon after, the group reassembled and headed back to the FACE AIDS house.

Joy and I with Innocent and his family

The next event planned for the day took some mental preparation. Our group received permission to visit the nearby Nyarubuye Genocide Memorial. I was personally especially apprehensive. The book I was reading to brush up on Rwandan history (We Wish to Inform You That Tomorrow We Will be Killed With Our Families: Stories from Rwanda) opened with a description of this site. The author, Philip Gourevitch, had visited only a year after the genocide and the church had been left untouched as a reminder of the atrocities that had taken place.

We pulled up next to a church filled with beautiful music; the town had gathered for a Christmas Eve service. A group of children was playing outside, laughing and running around. It was silly, but I had expected a crumbling building with stormy clouds overhead, which could match the heart-wrenching deaths that had taken place. The scene was instead so full of life standing in juxtaposition to the somber memorial site that I was initially thrown off.

The memorial had undergone some changes over the years and no longer looked just as my book had described. Many Rwandans had been laid to rest is a mass grave alongside the church. Others had been gathered and placed next to piles of weapons and clothing in the old church quarters where much of the violence had taken place. I was confused as to why they had elected to bury some and leave others in the room. Our guide then proceeded to explain an annual event. On the day designated to immortalize the genocide, the community gathers to clean and better preserve all of the contents in the room. It is a way for the living to heal and honor the memories of those who did not survive. Everyone was quiet on the drive back to Kirehe. We took time to reflect on the experience over lunch but for me at least parts will forever remain incomprehensible.

On our last stop of the day, we were welcomed into a roomful of singing boys to learn about one of our fantastic youth chapter projects. New Life Without AIDS has implemented a health education and circumcision project with the grant they won from the Practical Empowerment Program. The members of the chapter spent six months going to schools to educate students about HIV/AIDS, sexual health, and the advantages of circumcision.

With New Life Without AIDS Youth Chapter

When the time came to select volunteers for the circumcision program, the chapter was overwhelmed with interest from the boys. The funding could subsidize the procedure for sixty young men but over one hundred wanted to participate! A lottery system was implemented to select the lucky young men that we got to meet today. Their ages ranged from seven to twenty-three. We heard from a few participants about what they learned through the project and their satisfaction thanks to the great work of the FACE AIDS youth chapter.

Soon after we got back on the road. It was a long drive and by the time Nsanze delivered us back to the hostel everyone immediately plopped into bed. This was definitely the most memorable Christmas Eve that I have ever had.

-Laura Lynch, Stanford University ‘12

Our day in Kirehe was an incredibly special one. From meeting with the PIH District Project Manager to touring the Kirehe Hospital to eventually spending the night with Rwandarera, Friday’s festivities definitely made a lasting impact on me.

After driving to Kirehe, we stopped by the FACE AIDS house to drop off our stuff. At the house, many people were very excited to meet the FACE AIDS dog, Jumu. This of course led to bickering about whether dogs or cats are better, with cats naturally coming out on top. We then headed over to meet Alice Uwingabiye, the PIH Kirehe District Project Manager. There was a beautiful Christmas tree in front of Alice’s office to greet us. Alice was able to shed light on the history of Kirehe Hospital and the impact PIH has made in the Kirehe district. The Kirehe district is unique in that it is situated near the borders of both Tanzania and Burundi. Thus, one challenge for the Kirehe Hospital is handling the influx of patients from these bordering countries. Hearing Alice’s story of how she got involved with Partners In Health and seeing the pride that radiated from her when she talked about how far Kirehe has come because of PIH was truly inspiring. Once rated 3^rd out of the 30 districts for being most vulnerable in Rwanda, Kirehe, 5 years later, is now far from the bottom of the rankings.

Next, we walked over to actually see the hospital. Dr. Claude led a tour of the surgery room, c-section room, women’s and men’s wards, pediatric ward and the new five-room surgery ward. Kirehe Hospital treats an average of 150 people every day and has 13 doctors (ten Ministry of Health doctors and three PIH doctors). Interestingly, doctors in Rwanda usually need to know how to treat a wide variety of conditions; essentially they have to be a jack-of-all-trades in medicine. For instance, every doctor must know how to perform a c-section. Dr. Claude’s hope for the future of Kirehe Hospital involves acquiring specialists such as gynecologists, urologists, and cardiologists. This would ideally broaden the scope of conditions that could be treated and more efficiently and effectively provide care. Overall, it was great to see the progress Kirehe Hospital has made and continues to make with the support of PIH.

Dr. Claude

Kirehe Hospital

Making lunch was a group effort back at the FACE AIDS house. There were absurd quantities of delicious avocado, green beans, couscous with green peppers, onions and tomatoes, and fruit salad with fresh papaya, banana, mango and pineapple. If that’s not a scrumptious lunch, I don’t know what is!

Making lunch!

For the final event of the day, we drove to meet a community-based HIV association called Rwandarera. Once there, Innocent, a community leader led us to see some of their cows and then down an incredibly steep hill to their cassava and grass fields. The steepness of the hill proved difficult for those of us with ill equipped footwear and we found it easiest to side step down the hill. It was actually pretty similar to skiing! Down at the fields, we were surrounded with arguably the most breathtaking view of the trip. The community members spoke about the cassava trees, explaining that the leaves and roots are poisonous until cooked. Then, out of nowhere, one community member pulled an entire cassava tree out of the ground. It was kind of superhuman! We were then able to see the entire plant. After stumbling back up the hill, we headed over to Marie’s house. Marie, a member of Rwandarera, was cooking dinner for everyone. We helped cook the peanut sauce in a small mud hut separate from the house.

The head of Rwandarera then spoke about the differences before and after Rwandarera was established in the community. As a FACE AIDS pin-making association, Rwandarera members make the beaded AIDS-awareness pins that we distribute in the United States, generating a small income and entering a rotating savings program. The savings program has funded activities such as a livestock program and cassava farming. The profits from their activities are used for expanding farming areas, paying for Mutuelle (health insurance), and other items that benefit the association members. What was most evident during our visit was the hope and pride the establishment of Rwandarera has brought the community.

Next, every present member of Rwandarera and member of FACE AIDS took turns standing up and speaking about why they are a part of FACE AIDS. It was great to get everyone involved and hear from such motivated and accomplished people. Dinner then ensued and was composed of beans, rice, beef, fried plantains, fries, peanut sauce, meat sauce and Cokes! It was delicious! After such a delightful meal, we were left with our homestay families for the night. I was with Jordan, Dipika, and Amelia in Marie’s house. We had a great time talking to Marie’s 16-year old son, Gusenga, who spoke English very well. Our time spent with Gusenga included talk about school subjects, looking at each other’s photo albums of friends and family, and singing Christmas songs. I also thought it was pretty funny that the two people Gusenga mentioned from the U.S. were Barack Obama and Justin Bieber (“baby, baby, baby”).

My time in Kirehe was full of enlightening experiences that I will never forget! It was incredible to meet so many wonderful people, learn so many intriguing things and see a hospital that has made such immense progress with the support of Partners In Health.

-Nicole Bronson, Vassar College ‘13

Today was our second day spent in Rwinkwavu. We started the day with a hearty breakfast that included boiled eggs (a concept that fascinated and frightened me at the same time). Afterward, Cher-Wen led us in a discussion on Partners In Health’s Program on Social and Economic Rights, also known as POSER, an acronym I thought was funny. She talked about how POSER in Rwanda includes housing, education, agriculture, payment for Mutuelle insurance and hospital bills. Finally, she gave an overview of FACE AIDS Rwanda programs.

I was mildly surprised when I heard that there are close to 35 FACE AIDS chapters in Rwanda with 700-800 people. I had not realized that FACE AIDS had such a large presence in a country so small. The Practical Empowerment (PE) Projects has to be one of the most intriguing discussions we had in the entire trip. I listened intently as Cher-Wen discussed the projects that FACE AIDS had funded that year. My favorites were the circumcision campaigns (one we would later visit in Kirehe) and the drug use project.

After that, we piled into the bus with a social worker from Inshuti Mu Buzima and made our way to visit individuals supported by the POSER program. At the first home we went to, the mother proudly talked about her daughter for being educated thanks to PIH’s school fees program. We then went to a second home, which had just been built with the help of PIH. I was excited to hear that some of the FACE AIDS team had been at the same spot months ago, helping to build the house. The home visits especially highlighted the successes of POSER and PIH in trying to battle the social and economic determinants of health in the communities around Rwinkwavu.

After lunch, we made our way to meeting our first youth chapter in Rwanda, Intore Nyamibwa. There, we explored the gardens the chapter had built and they explained how Practical Empowerment helped them battle malnutrition in their community. We heard them talk at length about how successful this project has been, not only through the creation of family gardens, but also through education and demonstrations of the planning of a nutritious meal. All the while, we had the community’s youngest children following us out of intrigue. Finally, we visited Bosco’s home and family within that community and had a meal with them. He was extremely excited to open his home to us.

A family garden created as part of the malnutrition project

On the road back home, we had our first van sing-along. Back at Rwinkwavu, we had dinner with Toni, the Deputy Country Director, who divulged her story leading up to her involvement in Partners In Health. She is truly an inspiring woman. We ended the long day with a discussion about our values and the values of FACE AIDS and Partners In Health.

Tim, me, and Kundan

-Sohum Patel, Bellarmine College Prep ‘13

I want to start off by talking about breakfast. What we call the most important meal of the day is the simplest one for me usually. One bowl of cereal, plus or minus vitamins, that’s all I need. The two breakfasts I’ve had since arriving in Rwanda have been a bit different. Basically there’s bread, butter, jam, and I think I saw a crepe today. Oh, and lots of coffee. I should say that I did have cereal this morning, with very warm milk, but cereal nonetheless (it was cornflakes if you were curious). Breakfast items have always fascinated me, so thanks for indulging me for a bit there.

Today we met up with FACE AIDS Rwanda team—Program Managers Jean d’Amour and Caitlin, Program Assistants Theo and Bosco, and Program Associate Madden. I had met the dashing Jean d’Amour in Palo Alto at the FACE AIDS conference where we shared some beers and great conversation (the two are never mutually exclusive), so it was great to see him once again.

Nyamirama Health Center

First, we visited Nyamirama Health Center, the focus of this year’s Adopt a Health Center campaign. Upon arriving, I was struck by the fact that I was finally seeing the actual health center. For months we have been fundraising for this “mythical” health center and, sure, we had some pictures of it but seeing it in flesh and blood really put the whole trip (all two days of it so far) in perspective. At Nyamirama we met with Jacques the titulaire, or director, a terrific personality who gave us a thorough tour of the health center and held a question and answer session with us.

The health center, one of eight in Southern Kayonza District, serves 25,531 patients in 3 umadugudu, or villages. It’s the first stop for patients to obtain treatment. If necessary, they are then referred to a hospital, establishing a sort of hub and spoke system of health care. The government is pushing for a certain level of decentralization of health care, which probably bodes well for a country that is as densely populated as Rwanda. (Rwanda is, in fact, the most densely populated country in Africa.) Nyamirama also employs a social worker, Claudette, who told us about her position, including how she serves approximately 30 people per month. Since I am someone who hopes to work in the healthcare industry I think it’s important that I mention that it was during this Q & A session that I first learned about Rwanda’s health insurance system, Mutuelle. Rwanda is striving for universal coverage, and is currently at about 80% in Southern Kayonza District.

Jacques, Titulaire of Nyamirama

Obviously the health center has a long way to go—the vaccination building is an open shed rather than a sanitary environment to provide inoculations—but it can’t be ignored how much progress has occurred at this place. The renovation is occurring in two phases, with phase one close to completion and phase two set to begin soon. “This health center has many opportunities despite the challenges,” Jacques pertinently said.

Of course this visit was only half of our day. We next headed to Rwinkwavu Hospital where we had lunch and toured the hospital and fields. I think I’m starting to hang of Rwandan lunch. Potatoes, plantains, rice, and beans—carb heavy and very filling. We were thrown quite a curveball during lunch when a certain Dr. Paul Farmer walked in to join us. I had met him at the conference but I actually had not read Mountains Beyond Mountains at that time. Now that I have read the book, I was definitely more…awestruck when I saw him nonchalantly walking in. He was great of course, and talked about the history of PIH and Rwanda’s successes.

The Man, The Myth, The Legend

After that ridiculously awesome surprise we went on a tour of the agricultural area at the hospital led by Chief Agronomist Sebu. This is man is THE agriculture guru in the area. He showed us the fields and livestock in the hospital gardens. The crops are used for food at the hospital and the area serves as a training site for families with malnourished children.

A longhorn, obviously imported into Rwanda from Texas

Following this we were given a tour of Rwinkwavu Hospital guided by Dr. Chadi Cortas. Dr. Cortas is a physician from the U.S. spending 9 months of the year practicing in Rwanda and 3 months in Boston at Brigham and Women’s Hospital. It was really inspiring to see the high level of care that is being provided at the hospital. Especially illuminating was hearing him talk about the differences in practicing here in Rwanda and back in the States. He mentioned how he has to rely less on tests due to the lack of equipment and instead must rely more on the relationship with a patient to figure out what may be wrong. This was something that touched home for me. My mom, a primary care physician, talks daily about how she has to spend a good amount of time with her patients to figure out what’s wrong in order to avoid unnecessary, costly tests for her less-than-well-off patient population. The tour was probably the most personally inspiring aspect of day.

Touring the hospital with Dr. Chadi

After dinner we had an interesting reflection about service. We first read a piece called “To Hell With Good Intentions,” by Ivan Illich, which basically completely demonized charity in all forms. We then ranked different actions according to our own definitions of service and many of us were on the same page when it came to our rankings.

Today at Nyamirama, Jacques pointed out how the current maternity ward at the health center used to be a prison. The image of that transformation, a place of captivity to a place of birth, is one that really captures what is going on in the country as a whole. This country that was in such doldrums only 17 years ago has made quite a startling transformation. Regarding this transformation, Jacques also mentioned how he believed it was “one shared vision of/for Rwanda.” I intentionally put that slash there because I’m not completely sure which preposition he used. I actually have spent a good portion of the day thinking about which one he meant but now that I think of it, it really doesn’t matter. Both prepositions should be used. This is a vision that was created by Rwandans for Rwandans. The fact that the government is the one who invited Partners in Health in shows how committed the country is to providing health care for its citizens and how this drive is coming from the Rwandan people and not some force of neocolonialism.

Overall, I would say I’m having a good time so far.

-Kundan Verma, University of Texas at Austin ‘12

After a long day (or two) of travel had by all, we started our first full day of the 2011 Rwanda Student Leadership Trip with the reflection we were all too tired for the night before. Our first reflection required each of us to tell our “personal narrative” of how we came to be on the FACE AIDS Student Leadership Trip in Rwanda. This was definitely the best possible way to get to know each other as we all got a glimpse of what drove each one of us to devote our winter breaks to FACE AIDS. Each one of our stories was unique and enlightening.

We transitioned into an all-encompassing orientation for the trip and all headed off to lunch with our heads full of logistical information. Our first taste of Rwandan cuisine was served up at a restaurant called Fantastique in an enormous buffet filled with items many of us had never seen before. We got to know each other over lunch and then headed off for our first activity.

Our first major activity of the trip was likely the most informative and important: The Kigali Genocide Memorial Centre. For many of us, the genocide was only a story from textbooks before this day. Though we would soon learn how far Rwanda has come since this dark period, it was nevertheless important for all of us to gain more clarity of the history of this country before embarking on the rest of our journey. The mass graves outside were particularly impactful after we followed the long, detailed history of this country leading up and through the genocide of 1994.

Rose on a grave at the Kigali Genocide Memorial

Our first reflection that afternoon focused solely on each one of us helping each other to understand better what we had just experienced through an open discussion. None of us left the memorial with a clear mind and we all benefitted from the opportunity to learn together while trying to grasp the magnitude of what had happened in this country as well as how much progress has been made.

We were all ready to relax after reflection and found our way to Shokola Lite, a coffee bar next to our hostel. Shokola was equipped with cozy couches that welcomed some of our more jetlagged students to a quick nap even after we all ordered our first African coffees (coffee made with milk, cocoa, and ginger). We played some more unofficial “get-to-know-you” games and enjoyed our downtime before a great dinner to cap off an early night.

A view of Kigali from the road

Our first day was extremely informative; we quickly became comfortable as a group and felt eager for the next day of our journey.

Amelia and me

-Tim Spittle, Northeastern University ‘12