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Most people have a skewed perception of Africa. International media tends to focus more on negative news than positive growth. Strife and misery grab the headlines. Fortunately, there are positive signs of diversity and growth in Africa.
Rwanda is, in many ways, the exception to the rule: a country implementing new initiatives, despite expert predications of failure. This is especially so in an African context, in a country recently traumatized by genocide. Rwanda does not present itself with an idealized image of a country without challenges, but rather as one that is proving that good leadership linked with targeted effort can produce results. The capital city Kigali is an example: friendly and polite people, clean, safe, bustling with energy. Even the street-lights work – all the time – with second-to-second countdowns between red and green! There are even plans to turn the capital city into a free “hotspot” for internet users!
The Norwegian Nurses Organisation (NNO) partnered with its Rwandan counterpart in 2012, with Norad providing financial support. This partnership is still in its early stages, but can already show evidence of increased growth and recognition for our Rwandan colleagues. The picture below shows the Rwandan “team” in front of its newest transport acquisition, with a new and vibrant logo.

Rwanda Nurses and Midwives Union employees and an Executive Board member (far right) in front of their new vehicle – a first for the nurses of Rwanda thanks to support from NNO.
Great steps forward – great challenges remaining
Rwanda’s health care services needed to be rebuilt after genocide. A priority task was construction of local health centres. 20 years later we find numerous well-constructed centres spread across the country – often in remote rural areas. This ensures easy access for rural inhabitants. During the NNO partner visit in June this year, we visited one such center: Juru Health Centre in Bugasera District, in the east of Rwanda, a large, farming district with 380.000 inhabitants.
Our journey began in the capital city with an hour driving on nicely-paved roads, followed by another hour or so on rough, dirt roads. The drive takes us through rural farming areas with numerous banana groves. Curious children chase after us. Bystanders stop and stare, wondering who is visiting and why. Finally we reach our destination, Juru Health Center.
Our first impression is a well-ordered, clean and well-maintained health center, complete with flower beds and grassy plots. A uniformed nurse greets and welcomes us to the center. We have time for a chat before being guided around the center.
The nurses are proud of their work-place, but also admit to challenges. Just two ambulances are available to serve the district’s 380.000 inhabitants, often causing delays. The center’s maternity unit delivers some 80 babies each month, without the services of a professionally qualified midwife. 12 registered nurses have to cover a duty roster for all of the wards, 24 hours a day, including the maternity ward. Medical doctors and nurses are hard to recruit and harder to retain. The approved roster does not meet the politicians’ wishes for quality health care.
Juru Health Center.

Universal health care insurance
International experts were critical to Rwanda’s decision to introduce health care insurance for its inhabitants. Nevertheless the scheme has been a success. Simply put: everyone can subscribe for USD 5 annually. Even subsistence farmers can manage to pay the premium. If you become ill, then you also have to pay 10 % of hospital costs, unless for are unable to do so. If you feel unable, a local village council reviews your situation and can decide to waive fees. If you do not have insurance, you pay the entire bill.

Out-patient visitors waiting for treatment (printed with permission)

The road ahead for the Rwanda Nurses and Midwives Union is demanding. Even though progress in building a strong organisation is good, experience shows that “things-take-time”. Especially in Africa where the progress one achieves in life is often perceived as being at the expense of others. NNO is determined to stand shoulder-to-shoulder with its Rwandan counterparts until the goal of a strong, bold and sustainable organisation is achieved.

Text and pictures: Michael Paul Vitols
Rwanda, Kigali
22 June 2014

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