Friday, June 1, 2007

It's All About Saving Lives

It’s pouring rain outside as I write this. It’s the end of the rainy season here in Rwanda and the storms are just what you picture for a tropical rainy season: they come on fast and hard and the sound of the rain pounding on everything is an amazing reminder of the power of nature. There is a tree outside my window in which live at least 5 species of birds (those are just the ones I’ve seen and heard, including the one who insists on waking me up before the sun every single day). Every time it rains I try to see how the birds are fairing in a seriously blowing tree. But the rain is too blinding!

I’m glad the rain held off until the evening. Today I visited WE-ACTx, Women’s Equity in Access to Care and Treatment. WE-ACTx is another local organization supported by American Jewish World Service (but like so many local organizations, WE-ACTx still struggles for adequate funding).

WE-ACTx was conceived to meet the needs of women who were raped during the genocide and acquired HIV as a result. Estimates vary, but in general people believe that somewhere between 250,000 and 500,000 were raped during those 100 days, and 75% of them got HIV as a result. During the genocide, rape to pass on HIV was policy, a genocidal decision that means that for many women the genocide continues to this day. Although associations for women living with HIV had sprung up across Rwanda (and there are still over 1000 such PLWHA associations here, in a country the size of the state of Maryland) genocidal rape survivors needed more than just antiretrovirals to treat their AIDS. They also needed psycho-social care and health services for their families. So WE-ACTx decided to fill this need.

I met with a range of staff at WE-ACTx’s office and toured its downtown clinic (it operates two other clinics, as well as a clinic for voluntary counseling and testing for HIV). All of its 4000 clients receive free care, including pricey AIDS medicines and psychotherapy, both in groups and one-on-one when they need intensive mental health care. A number of the 4000 clients are children, and, if memory serves, around 400 of these kids also have HIV. It’s an absolute tragedy. Some got it from mother-to-child transmission during birth or breastfeeding, but surely others got it because they had high-risk sex—either they were raped or they traded sex for something they needed, one of the saddest decisions a poor person can be forced to make. But thanks to the compassion and vision at WE-ACTx, these kids, and their parents, can get the lifesaving care they need. As long as WE-ACTx can afford to buy the medicines.

Some of you may know that my mom and step-dad are both mental health workers, so I am particularly attuned to the need for mental health care, especially in a country such as this, where I believe that almost everyone suffers from post-traumatic stress disorder. In so many countries, especially in sub-Saharan Africa, mental health care is a luxury. Few universities offer training or degree programs, and few people could even afford to go to a therapist anyway. Plus the stigma of such a need is still really high. In many ways, Rwanda is no exception. The difference here is that something happened that made EVERYONE realize what mental health is and how it can affect life. As a result, the government developed a degree program for clinical psychologists at the university here in Kigali, and the Swiss development agency designed a training curriculum for lay-counselors to use in addressing trauma across the country.

Of course, there still aren’t enough counselors. But I’ve written into the proposal I’m here to produce a drastic increase in trauma counselors. I really hope we get funding for that activity. Not only is mental health important for its own sake, but it’s important for AIDS too. Traumatized people are less likely to consistently use condoms, and more likely to use drugs and alcohol—which we all know impairs our decision-making skills. That means that trauma is a risk factor for HIV/AIDS. So far, Rwanda’s HIV/AIDS prevalence isn’t as high as some neighboring countries, and we’d like to keep it that way. An important factor will be to address the trauma suffered by nearly every resident of this tiny, beautiful place.

Tomorrow I’m off to experience some of the local beauty—heading to Volcanoes National Park for a trip to see endangered silverback gorillas high in the mountains near the Congolese border. I can’t wait! It will be quite a change from budgeting and proposal writing here in the city. To be continued…

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