What one learns on a last minute field trip...

Kinyarwanda word of the day: None

The past two weeks I have been assisting with a social work certificate course at the school, and Tuesday I found out that we would be going on a field trip to Nyagatare a small town in the north of about 8,000 described in the guidebook as "an act of febrile distortion to describe Nyagatare as any sort of travel magnet." Travel magnet it wasn't--but i did have some of the best African tea ever at the Sky Hotel--but it was interesting to take a look at some successful HIV programs in the area.

Sadly, my Kinyarwandan is not where it should be-though i just learned several fun words talking to the kitchen staff here. i.e. soup=isupu and today=none (hmm...interesting existential question for rwandans?). Anyway, unfortunately today and soup where not prominently featured during the discussions, and while adding "i" before several english words works, its not helpful when trying to understand first hand accounts of people living with HIV and stigmas associated with it. (luckily several students in the class acted as translators for me..)


For someone who has been studying/working in HIV for several years now it was incredible, touching and devastating to see first hand (as opposed to a written case study) the daily challenges people face here. One women, after revealing her health status to her family, was treated like a farm animal; she was relegated to a small shed behind the house, and fed small food scraps once a day. She was left for dead, when her sister intervened and carried her miles to the nearest health clinic. This amazingly resilient woman is now a leading HIV advocate and vice president of the women's association. She also helps out at a nearby income generating association for AIDS/genocide orphans ages 16-21. About 20 girls crammed into a small room with 5 sewing machines, learning how to hem, with hopes of making and selling school uniforms for a nearby school.

Next on the itinerary was another health clinic a stone's throw away from the Ugandan border. This remote post has had extreme success in getting people to come in for voluntary testing and counseling by sending a team of HIV positive volunteers into the community to encourage people to get help. Over the past few years, this clinic went from having maybe 10 people come in for testing a month to hundreds because of these community outreach workers. One of these volunteers has been on Anti-retrovirals for 22 years, and is a figure of hope for the rest of community. Thanks to ARVs, HIV does not mean an automatic death sentence.

The next stop, however, was not as rosey. Our last stop of the day was at, what i understood, the only hospice in the country where people without any family or relatives come for treatment or, more often, to die. I can't imagine a more peaceful place to spend one's final moments, in the midst of banana trees over looking the rolling hills of Uganda. Yet, with no government financing and major overcrowding, it seems like a rather hopeless venture. They rely entirely on private donations for support, and while everyone in the class forked over several dollars for the effort, i just don't see how this hospice will survive in the long run. A boy who looked to be about 20, who was the volunteer director of the hospice described heart wrenching stories of people begging to stop taking their medication because they preferred death; and this 20 year old boy with no formal education serves as a counselor, doctor, and family for these people with no one else. for free.


So it was an amazing, yet depressing field trip, which made me glad that I've chosen a path in public health. The sacrifices people make for one another can be truly unbelievable. and give new meaning to the expression "none" is good...