Wednesday, May 30, 2007

Raising Local Voices

A large portion of the work I do relates to the nexus of violence against women and violence against children and HIV/AIDS. Sometimes this connection seems fairly obvious, especially when we’re talking about rape. Sometimes it’s less obvious, like the case of physical or emotional abuse, but there are still important links (if you want to know more check out our Zero Tolerance report, linked below). In the US, if a woman goes to a doctor with bruises, broken bones, signs of violent sex, doctors will often ask questions to figure out whether she is being abused by someone. This oversight is even more pronounced with children, whose teachers are often the first to intervene in cases of child abuse, because they have been taught to recognize the warning signs. Of course, many many cases of abuse go unnoticed or are consciously ignored—even in the US we often think of abuse as a private matter. But it isn’t. It is a human rights and public health crisis, and it happens all over the world.

There are a lot of links between violence, especially sexual violence, and sexual and reproductive health (SRH). We often have to make this argument, but here in Rwanda, with this country’s history of violent rape associated with the genocide, and the serious sexual and reproductive health consequences of it, the links between violence and SRH are actually policy. And in fact, a major reason I’m here supporting Rwanda’s Round 7 Global Fund proposal is that the country wishes to expand services to prevent and respond to violence against women and violence against children as part of its national HIV/AIDS efforts.

While I’m here I’m trying to gather information about how things work here, the types of services that exist and are successful, how much they cost, etc. So today I visited the Rwanda Women’s Network, which receives support from one of our close partners, American Jewish World Service. I spent a few hours talking to Mary Balikungeri, the founder and director of Rwanda Women’s Network, which runs the Polyclinic of Hope and the Village of Hope. These programs are innovative and exciting, and Mary’s enthusiasm for her work was absolutely contagious. The Polyclinic provides services for women and children who have experienced sexual violence—human rights awareness programs, trainings on legal procedures and support for the legal process for those who decide to file charges, basic health care and HIV/AIDS services, and socio-economic empowerment. I’m trying to apply this model as I write the SRH and HIV prevention components of the Global Fund proposal, and I learned so much today about the importance of empowering local communities to advocate for their own needs and to support one another when violence takes place around them.

At one point, Mary talked about how fundamental it is to consider Rwanda’s history (the genocide of course) in trying to plan programs that focus on letting Rwandans live together in peace. She said that she wonders if the genocide ever would have happened if communities, especially the women in them, had been empowered then as many are becoming now. She said that if Rwandans don’t want to go back to that point, they must focus on raising the voices of the Rwandan people starting from the most local level. I truly hope that the Global Fund will see that the voices of individual women and children who have experienced horrible violence must be raised, and that the best way to do that is for the Rwandan authorities to provide financial support to community leaders and community-based grassroots organizations so that they can articulate their own needs and desires. I am glad that Rwanda Women’s Network has been doing just that, and I (and Mary too!) am grateful for American Jewish World Service’s support of such an outstanding organization!

With this in mind, I’m now off to continue costing the HIV prevention activities we have proposed for Round 7. Those of you who know me are aware that math is not my favorite thing. Yet, when so many lives potentially hang in the balance, I will muster the aptitude and strength to do math all night long!

Sunday, May 27, 2007

Thoughts on Rwanda's Kids

I brought some DVDs here to Rwanda to watch on my computer, and last night, in honor of Friday and a weekend of work ahead of me, I watched the South African film Tstosi (mild spoiler warning here, but also a strong recommendation to those of you who haven't seen it; it's an exquisite, heart-rending movie). After it ended, I stood in the window of my hotel room looking out at the lights of Kigali spreading below me and up into the hills that surround the city, and I kept thinking of all the suffering—and all the surviving—that was going on at that very minute in the very place I am right now.

There was so much in Tsotsi that is real. The ways that people will do anything to live, find any way to keep going and to meet the needs that each of our bodies and souls have. Somewhere below me and all around this country are children who are alone. Their parents might have died in the genocide or of AIDS, or maybe they were abandoned or left home like Tstotsi did, only occasionally looking back, fighting for survival through pain and sickness, hunger and trauma, and above all, loneliness. They may not even be able to feel anything or to remember a time before this one, but no matter what, they keep going. I guess life just seems worth living. There are people who are driven to do terrible things in the name of survival, but in the end they are still human, still motivated by the same things that cause orphans to band together, women to sell their bodies to feed their children, men and boys to jack cars and sell them for parts before going home to kiss their mothers and wives hello. Somewhere in the hills around me is a group of kids trying to survive as one, dealing with whatever memories haunt them, still drawn to human companionship despite it all, no matter how much people may have disappointed or hurt them in the past.

Sometimes the work I do starts to feel like just any other industry, the business of saving lives. We can argue over petty things sometimes, or lose track of the big picture as we get bogged down in strategic details. Some people even lose their connection to their hearts and compassion, the things that drew them to this work in the first place. In Washington or here in Kigali, surrounded by people who work for USAID and the Global Fund and the UN and all sorts of NGOs from around the world, it can occasionally feel like a job is a job is a job. People joke that I am a do-gooder, trying to save the world. Sometimes I think my friends say it because they have the confidence that I can actually make a difference, but sometimes I think it is a comment on the fact that there are so many of us and that global health, human rights and humanitarian work are themselves just another field, like business or technology. But the truth is that we ARE trying to save the world, as many lives as possible at a time.

Although it was just a movie, Tsotsi reminded me that I do this work for a reason. Yes, I'm a bleeding-heart who just cried through a movie and then cried harder looking out my window. Yes, I believe that people are good, and that when people do bad things they deserve our compassion and our effort to understand the experiences that drove them to it. And, yes, every now and then I feel like my job is just that: a job. But I look around the streets of Kigali and I remember what happened here in 1994 and I look at the hope that is here now, the very clean streets, the sense of complete safety I feel walking alone through the city or getting into any taxi I see, the sincere desire of the government to make this country the best it can be, and I know that through all the tragedy and trauma and sadness and heartbreak, underneath it we all want life. Joy and laughter and love, too, but most importantly, life. Yet, in trying to preserve life, we manage to sometimes find those other things, too, even when life is as hard as it can be.

In a meeting yesterday with the consultants writing Rwanda's Global Fund proposal we discussed the number of orphans and vulnerable children here in Rwanda. The new assessment is astonishing: 56% of all Rwanda's children are estimated to be orphans or otherwise vulnerable. The thing is that, unlike most of the rest of the world, this proportion is expected to decline over the next few years. While progress in fighting AIDS and in providing treatment for those who need it is part of the reason, another reason is that the last of the kids orphaned by the genocide will turn 18, will no longer be kids. So where does this leave them? I guess the lucky ones got services, got an education, will be able to have healthy educated families that will rise out of poverty and contribute to this new, post-genocide Rwanda. But many still struggle, living in shacks or in ditches or doorways, wandering the city barefoot and begging for food in a language I cannot understand (today one of my new young friends was needlessly hit on the head by a policeman's baton while he sadly watched me drive away in a taxi), shaking with malaria's fever or dying of AIDS.

It sounds so melodramatic, so hopeless. But it isn't. Here are a few truths: People will do almost anything to survive because something inside us tells us that life is an adventure worth living; and we can help them. Yes, my job is part of an industry dedicated to making the world a better place. But our goal is what's important, not the size and scope, or the fact that sometimes we spend too much time away from the reality that we try every day to get Congress to confront. So many people do not know pure happiness, don't remember their mother's loving arms or their little brother's laugh—or maybe even the sound of their own—but there are ways to make this world a better, brighter place. I guess in the end, no matter how sad it sometimes makes me, I'm glad I've found my way to contribute. I hope that everyone else can find a role to play, too.

Thursday, May 24, 2007

I'm In Rwanda!

I never thought I'd be able to say (or write) this, but I'm in Rwanda! I'm here as an advisor for UNAIDS to work with the Country Coordinating Mechanism of the Global Fund to Fight AIDS, TB and Malaria on its HIV/AIDS proposal, due in July. That's a mouthful! Actually, it's very exciting. Links between sexual and reproductive health and HIV/AIDS seem obvious--both have a lot to do with sex--but very few countries have made a real effort to integrate these services and to make them available nationwide. Rwanda, along with a handful of other countries, is prioritizing this integration for its Global Fund Round 7 proposal. And I get to help them do it!

Sexual and reproductive health (I'm calling it SRH from now on, 'cause that's too much to type every time) includes things like family planning and contraception, pre-natal and post-natal care, HIV counseling, testing and treatment for sexually transmitted infections, and recognition of and response to gender-based violence, especially sexual violence. Sadly, Rwanda has a history of sexual violence stemming from the 1994 genocide, during which as many as 500,000 women were raped and about 75% of them acquired HIV. Unfortunately, the phenomenon of widespread rape has apparently continued, with mostly orphans and other vulnerable children being the target. Thankfully, Rwanda's leaders in responding to the HIV/AIDS epidemic here recognize the importance of incorporating SRH and gender-based violence in all settings that provide HIV/AIDS services. So I'm here to help them figure out how best to do it.

I'll write more later on work stuff. For now I have a few more personal things I want to say. First, Kigali is a beautiful city. There are tree-covered hills everywhere you look. People are so friendly. But there is still a weight here, a memory of horrible atrocities that took place only 13 years ago. The Rwandan people have tried so hard to build a harmonious and compassionate society in the wake of the genocide, and I can tell how important this is to them. They have a quota system, so that at least 30% of elected officials and high-level offices have to be women. I've been told this is because they believe that if more women had been in power in 1994 the genocide might never have happened. There are signs of hope everywhere. Yet driving down the streets I keep picturing the film "Hotel Rwanda," and it almost makes me cry to think of what took place on these quiet streets filled with women carrying plantains in baskets on their heads and men strolling into downtown. Everyone points out the Hotel Mille Collines, the hotel in which "Hotel Rwanda" takes place, as if it's assumed I know its history. It's really intense. And yet my purpose in being here is evidence that things are changing, that the government and the people are determined to set an example for post-conflict development and peace. I know they can succeed!

So, I'm off to eat dinner and prepare comments on the current Round 7 proposal, so that tomorrow we can really begin the work of building SRH and violence services into all HIV/AIDS services here in Rwanda. Till then...