HIV Caregivers with Miss Clarisse
After breakfast and morning devotions/sharing we headed out from our hotel to Kivuruga once again this time to begin our day at the home of 24 year old Clarisse who is HIV positive. We were initially met by Florence who is the volunteer in charge of the 126 Kivuruga ADP volunteer caregivers (56 men, 70 women). Two other caregivers were there to help us understand the process. There were other neighbors and family there as well as a number of neighborhood children (as always).
The Caregiver program started in May 2008 to encourage HIV positive people to accept themselves, keep hope, and follow the instructions given by caregivers and doctors including taking their anti-retro virus (ARV) medications. Before the World Vision program they lived in isolation with deep stigma and now have a sense of belonging and hope. Part of the program is to discourage pregnancy because of how it weakens the body and hurts the immune system when the woman is HIV positive. The caregivers bring food to families and encourage them to eat a well-balanced diet; WV also does the same for those left orphaned as a result of AIDS. Currently 307 people in Kivuruga have come out with an acknowledgement that they have HIV or AIDS. Once World Vision is aware, they encourage them to join associations.
Clarisse shared that before she acknowledged her status, joined the association, and listened to the caregivers that her hair was turning bad and her feet were swollen, but after these things she was filled with joy to have people help her. The ARVs she takes required a balanced diet; the animals given by World Vision provide milk and also produce manure which is used to grow crops; both of which lead to a more balanced diet.
The WV caregiver training includes sanitation and hygiene; prior to their involvement, the house was much dirtier. WV also provides pigs for those suffering with HIV both for money when they sell them, but also for the manure to improve their plants. The caregivers then went through the different things that are in the kit and thanked us so much for providing these so they can do their ministry. WV also has given them umbrellas as boots. WV support leads other people to come forward with their status which leads to more people impacted. Another element WV provides are bead necklaces used to understand the fertility cycle and family planning for those that will be engaging in sexual activity. We asked if this ministry would exist at all without the presence of World Vision and the answer was a resounding ‘no’; World Vision through the sponsorship dollars and unbelievably committed volunteers is literally saving lives in Kivuruga, Rwanda…. So thank you to all you sponsors.
The main challenges the caregivers are facing include the vulnerability of families without food as their immune system is even further threatened; they also struggle with transportation and would like to have bikes to travel; also, they would like to have rain coats as they are easier to continue to do work rather than umbrellas. Hearing this, Pastor Joel grabbed his rain jacket and gave it to the lead caregiver. Others followed suit and they were given about 8 raincoats or ponchos in total. After walking to the jeeps, we were able to give them many other things that we had including medical supplies and about a dozen Norwex anti-bacterial towels (these will be much more comfortable and effective for washing these patients before they begin treatments). These Norwex towels were donated toward the trip and we could not think of a better use.
The volunteers (Florence, Innocent, and Daryl) visit patience depending on the level of their illness. It may range from every day to once per week. In addition, twice per week they travel the villages trying to raise awareness of the help they can give and encourage people to open a conversation with them. The caregivers are trying to start an association to grow crops & livestock and they want us at the launch!!! They were so excited to think about us helping to launch this transformational work.
Nutrition Center & Medical Facility
Our journey continued with perhaps the most impacting element of the entire trip for many of our team. We traveled to the Bushoka Nutrition Center and Medical Facility led by Edith and her nutritionist Solan. World Vision assisted in building a new kitchen at the facility that is now about 2 months old (through sponsorship dollars) as well as training the cooks on how to prepare a well-balanced meal for those who would be receiving it. When we were there, they were cooking cassava leaves with oil & ground peanuts to provide protein, vegetables & nuts. They were also cooking rice with carrots and preparing a fruit cocktail with a number of local fruits. They were also preparing a juice made from passion fruit and carrots. Although the initial cost of the kitchen were borne primarily by World Vision, most of the food supply comes from parents bringing food when they are able (they wish to start an association also) otherwise money comes from World Vision and the Center staff purchase the necessary food. Some of the other elements are donated by WV including pans, buckets, plates, cups, tables, and chairs.
We found out that every day, volunteers travel throughout Kivuruga looking for malnourished children under the age of 5. When they are found, they are first weighed and measured to determined their status. If they are Green, they stay in their homes in the community. If they are Yellow, they stay with their families but are eligible to receive one meal per week at the Nutrition Center and the mothers are taught nutrition. If they are red, they receive one meal per week for about 1-2 months and if their situation does not change, they are transported to the hospital. Children under 6 months old that are found to be malnourished are transferred to the hospital right away. The meals are typically served on Thursday, but a special Tuesday meal was prepared because of our visit.
The Nutrition Center also has a cow that gives milk used as part of the meal and also given out daily to eligible children. The cow cost about $600,000 RWF (about $1,200 USD). There is a field near the cows that the mothers of the children work together to ensure the food are available; this includes carrots, mushrooms, green peppers, cabbages, and tomato trees. The Nutrition Center teaches about how to grow seedlings; the women bring the seedlings home or just take their learning and go plant at their home. The meals and milk that are provided are completely free. The funding for the ongoing costs comes from the government, food from the community & parents (when crops are good), and World Vision as needed to supplement the other sources.
There are 28 villages in Kiuvurga ADP and the goal is to have a full Nutrition Center in each one. Bushoka is the first one to be launched in the Kivuruga ADP.
We then toured the medical facility which has a nurse with no medical training (although she has been a nurse for 10 years), no electricity, and no running water. We visited the maternity room where babies are delivered; the room is about 10’ by 10’ and has two deliver beds but does not have electricity, a sink, a drain in the floor, or a place for the baby after birth. Prior to birth, mothers wait in the regular waiting room with the rest of the people (including people suffering from all sorts of ailments) and immediately after delivery they are moved to that waiting room. The maternity room covers all of Kivuurga and has about 50 deliveries per month. No surgeries can be completed here so if there are any complications at birth, an ambulance is called. The nearest hospital is about 25 miles away and road for the last few miles to get there was the worst one we traveled in all of Kivuruga; in fact, often the road is flooded and they need to walk the woman to meet the ambulance. The 50 mile trip will take a minimum of 90 minutes. This was very moving to me as, given my personal family situation, if we lived in Kivuruga there is a high likelihood that my son Ryan and my wife would have died during his birth. What an injustice of geography. The cost to get the maternity room improved is about $120,000 USD and a proposal was submitted in October to World Vision and is currently under review.
One of the issues facing Kivurugans with health care is that the lowest cost of insurance has doubled. Previously they would pay about $2.50 per year for limited access coverage and the cost has increased to about $5 per year for a more comprehensive plan. This difference in cost is too much for many who live in Kivuruga and they therefore do not have health insurance. The uninsured can get coverage, but only in an emergency situation.
The health clinic also performs immunizations for children birth to 9 months. On the premises is a medical laboratory that was built by the Rwandan government through the U.S. Global Fund.
After the very difficult tour of the maternity area and the rest of the clinic, we walked back to the Nutrition Center where we participated in feeding the children. This was very moving for all of us as well as these children were all severely under or mal-nourished. We heaped up their plates very high; these were full size plates that we packed with food. We then delivered them to the children and their mothers helped feed the children. This food was more than I could eat and the kids were gobbling it up. It is clear that they have not eaten well (if at all) since at least the week before. Knowing the mothers do not eat well either was difficult because they were watching their child eat this huge meal without getting any for themselves. It was a moving picture of a mother’s sacrificial love.
Once we were done serving meals, we couldn’t stay much longer and it was time to say goodbye. As we left, we were met by the Nutrition Center staff who presented us with two beautiful gifts that we will treasure for ever as evidence of the impact Our Response is having.
Life…. Kivuruga Style
After lunch, we went to the home of a family that lives near the Kivuruga ADP and helped them with their daily chores. Some of the group took their empty water jugs, went to the water source, filled them, and brought them back. The ladies who didn’t do water tried their hand at weaving a rug while the guys that didn’t go (Eric & I) helped the old man of the house work on weaving a winnowing fan. After our time weaving, I chatted with the old man about the differences of life in Kivuruga vs. life in America. He said that it sounds like we (Americans) work hard and therefore have much more money that those in Kivuruga. I wanted to scream that we (me) work about 1/10 as hard as they do and somehow get paid many multiples more (the average annual income in Rwanda is $240 USD). It was a difficult, but wonderful conversation as we navigated the pros & cons of our two different countries and lifestyles. Part of our conclusion was that the difficulty of Rwanda also led to one of its advantages that the family and community are always together, dependent on each other, and therefore build wonderfully tight relationships with each other (something that we in the U.S. desperately need).
After this time, we traveled back to our hotel in Musanze.