Kanembwe is a new village located in Busigari cell near Gisenyi in northwestern Rwanda. Until two years ago, the area was a small forest. But there were people living inside or on the outskirts of Gishwati in northern Rwanda, a major forest located on the mountain chain that is known as the Congo-Nile Divide. Human activity placed a heavy burden on the forest, and increasingly led to a variety of landslides and floods. As a result, the government decided to relocate all the people living in the area and to create a new village called Kanembwe.

Visiting Kanembwe

My first visit as a new Operations Officer at Eos Visions Rwanda took place in June 2011. We had the desire to develop an excursion to Kanembwe that would explain the environmental issues facing Rwanda to interested visitors. The road was in a terrible condition, and I was starting to wonder why we actually had to go and develop an excursion in such a remote village. While we enjoyed the welcome by traditional dancers in casual dresses, the very chaotic first meeting with the community leaders disappointed me further. Everybody was basically speaking at the same time, and all I could see was that these people were very poor and illiterate. Frankly, I understood why they were interested in working with us because they needed something to do to improve their living standards – but I failed to see why we needed them. Their vague questions were all the same and we had to explain everything again and again. The only enjoyment was that we had the chance to spend a day out of our office and actually be tourists in our own country.

When the second visit came up, I only decided to join because I didn’t want to disappoint my boss. After a two-week trip that I guided for a group of Swiss high school students, all I could think of was a day off. To make things worse, I was put in charge of doing the talking in the community and with the local government officials that we met in Kanembwe and in Gisenyi. Again, the experience was rather chaotic, but the picture of a potentially exciting excursion started to form in my mind. Two weeks later, my boss told me that the company had indeed decided to develop a partnership with Kanembwe and that they wanted me to be in charge.

We involved the Vice Mayor as well as the Executive Secretary of the Sector who agreed to attend the first major meeting in person. Initial mistrust by the villagers soon turned into an excellent relationship. And since they felt uncomfortable to dance in their casual clothes, we agreed to give them a loan to buy dance uniforms. Just a week later, they were ready for a first test tour which was a great success.

Today, four months later, we already brought 7 delegations to Kanembwe – 88 individual visitors. And all of them tell us that this is the most precious and exciting excursion of their entire Rwanda trip, a real highlight. In the process, I became a big fan and a good friend of the villagers. Sure enough, it can be annoying to be woken up around midnight by one of them who simply wants to say Hi. But I learned to understand that, due to missing electricity, they go to bed very early and get up around midnight when they have nothing else to do but to call a friend who lives in Kigali and happens to be me. I now understand that they do it out of love, and I learn to really appreciate the calls.

Kanembwe dancing

And the benefits to the community are fantastic. The 88 visitors obviously had to pay for their excursions – money that we pass on to the community. Until now, this produced more than $700 for the individuals from the village who are involved in the visits on a rotating basis and who thus perform a service that they get paid for, plus over $1,000 for the community development fund that we have set up to benefit the entire community. Some of the visitors also volunteered to help further. One of them, a psychologist, for example, decided on the spot to pay for the health insurance of 100 children from the community.

I can say that, today, when I’m in Kanembwe, I feel truly at home. Everybody knows me and even very young children call me by my name. I honestly don’t think that I could have found the joy that this project provided me with anywhere else. Dancing with them is always one of the best moments of my job!

We began the professional program with a visit to the National Organization of Users and Survivors of Psychiatry (NOUSPR), whose name turns out to not be a mistake of English grammar. As one of the volunteer coordinators explained to us, in Rwanda many people are in fact “survivors of psychiatry” because treatment can often be just as damaging or debilitating as one’s initial condition. Our visitors had the chance to hear the testimonials of some NOUSPR members, learn about the challenges facing mentally disabled or ill people in Rwanda, learn about the organization’s goals for conducting research, and share their own initial impressions of the state of psychology in Rwanda in addition to personal stories.

Psychology delegation to Rwanda

Rwanda has only one psychiatric hospital, the Neuropsychiatric Center of Ndera, and our delegates were eager to offer their assistance through a special training session. The Center’s managers requested a presentation and practical training on drug and alcohol addiction, a topic that is unfortunately of great relevance to the local practitioners but to which they have very limited access. Our visitors gladly responded to this request and provided a session that outlined concrete tools that practitioners can use to identify and treat alcoholism and addiction.

In an effort to help build academic and institutional capacity in the field of mass trauma treatment, the group visited the Kigali Health Institute, the capital’s leading medical academic institutions, and two psychologists gave a presentation on mass trauma treatment. The audience consisted of psychologists, heads of departments related and unrelated to psychology, and academic administrators. What emerged from the ensuing discussion is the importance of incorporating psychological principles and awareness into all fields, even seemingly remote medical areas such as dentistry.

The professional program concluded with a visit to the country’s National Unity and Reconciliation Commission in order to learn about the role and consideration of peace psychology in Rwanda. Delegates particularly enjoyed a dialogue with the Commission’s Executive Secretary, Dr. Jean Baptiste Habyalimana, and it became clear that psychology played a large role in the design and implementation of the Commission’s activities.

The feedback from this group mirrored the experiences of three other delegations of mental health experts that we have hosted in Rwanda in the past. They thoroughly enjoyed the opportunity to exchange their expertise with the local practitioners and to learn about the state of the field in Rwanda, a country that, due to its recent history, presents a very challenging environment to practitioners. They also realized that the identified needs for further training, education and experience exchange, coupled with the Rwandan open-door mentality, provide great opportunities for visiting professionals to be involved and make a meaningful contribution. Several delegates are planning to return soon, with concrete ideas of engagement, and we are also discussing with institutions such as the National Board of Certified Counselors in the US to bring specialized master trainer programs like the Mental Health Facilitators to the country in 2012. If you are interested to contribute to these ideas, please contact us.

The Kenya Hospices and Palliative Care Association (KEHPCA) was established in November 2005, adding a strategic framework to an organically-growing network of hospices. There are now a total of 32 hospices and palliative care units across Kenya. These offer palliative care for those suffering from terminal disease, originally just cancer, but more recently, HIV/AIDS and diabetes, as well as counseling and support to families.

Advancements
Kenya’s hospice and palliative care system has progressed significantly since its inception in 1990 and the country continues to pioneer new approaches. After 20 years of tireless campaigning by very few key individuals in Kenya, the government is now beginning to legislate. This breakthrough was heavily influenced by policy-makers being exposed to and inspired by the work of the Nairobi Hospice. Its representatives sat on the committee to develop the Health Sector Strategic Plan, and they are working with the Ministry of Health to help develop specific palliative care guidelines for cervical cancer.

The second huge advancement is a general phenomenon in Kenya but has even extended its impact into palliative care. That is the wave of mobile phone technology sweeping the continent. Ubiquitous use of mobile phones, even in remote regions, has enabled those suffering from chronic illnesses to connect to support services. For example, many people who would otherwise be unable to make a telephone call to seek advice or afford transport to the nearest palliative care service are now able to request advice, support and test results via mobile phone. There is even a frequent occurrence of “flashing” (ring but not let the call go through and then to have a nurse return the call) so that advice and support could be given at no cost to the patient. This exponential trend has been critical in enabling volunteers to do their work, in encouraging them, and in supporting patients and their carers to remain in the community.

Recent years have seen significant progress in embedding palliative care within the curricula of wider healthcare professionals – and Kenya is really leading the way in this space. This has, once again, been primarily driven by KEHPCA which has been working with 17 institutions and has trained 61 lecturers in the inclusion of palliative care issues in general health training.

Challenges
Despite the significant advancements, and the fact that Kenya is one of the leaders in this field in Africa, unfortunately the promising examples remain ‘islands of excellence’, the use the words of the World Health Organization. In 2004, Kings College London wrote a report highlighting the core steps to service development, and these remain key hurdles today:

1. Advocacy (national policies and guidelines)
2. Integration of palliative care into the continuum of care
3. Scaled up financial and human resources
4. Education, training and research
5. Drug access, specifically the acute lack of access to opioids
6. Prevalence of HIV, cancer and diabetes in Kenya
7. Pediatric provision
8. Cultural barriers

The challenges described make it virtually impossible for the hospice and palliative care sector to scale-up and achieve sustainable critical mass. Research reveals that excellent examples are evident in pockets, but the provision is barely scraping the surface of need.

Opportunities to learn, network and contribute via an Eos Visions tour

• Share best practice around advocacy to further raise the awareness of the issue at government level as well as internationally, including the specific issue of access to opioids
• Understand the challenges around integrating palliative care with general healthcare practice and offer lessons learned
• Support in resource mobilization to increase funding for hospice and palliative care services
• Share expertise on capacity building and training of staff, specifically exposure to western models of care
• Explore links with Kenyan and international universities to research issues
• Brainstorm monitoring and evaluation strategies in hospices and palliative care
• Topic discussion around HIV, cancer, diabetes and pediatric palliative care needs
• Understand the cultural barriers to accessing palliative care in Kenya, specifically via grassroots civil society organizations (usually faith-based)

About Global Entrepreneurship Week (GEW)
During one week in November, GEW inspires people everywhere through local, national, and global activities, designed to help them explore their potential as self-starters and innovators. These activities include large-scale competitions and events, workshops, discussion series, awareness campaigns, and intimate networking gatherings, and many other opportunities that work to build connections and unleash ideas.

GEW was launched in 2008 by former UK Prime Minister Gordon Brown and Carl Schramm, the president and CEO of the Ewing Marion Kauffman Foundation. Since then, it has grown to 113 countries – with nearly 24,000 partner organizations planning more than 37,000 activities that directly engage more than 7 million people. GEW enjoys the participation and support of presidents and prime ministers on every continent, including President Barack Obama (US); Prime Minister David Cameron (UK); Prime Minister Benjamin Netanyahu (Israel); and Prime Minister Stephen Harper (Canada).

About Global Entrepreneurship Week Rwanda
Rwanda is gearing up for its first ever Global Entrepreneurship Week, and has already planned a diverse array of events, including: a Business Plan Competition hosted by the Rwanda Development Board, a Creative Economy Expo hosted by the Private Sector Federation, an Essay Competition hosted by the Education Development Center, a Film and Roadshow created by Bridge2Rwanda, Radio Talks presented by Never Again, and a Self-Help Expo hosted by the US Embassy. There will also be an awareness campaign, Youth and Innovation Awards, and a Business Planning Workshop, and many more events that are currently in development.

Individuals and organizations can get involved in a variety of ways – from attending and participating, to hosting, coordinating, and sponsoring events.

More information
GEW International Website: www.unleashingideas.org
GEW Rwanda Facebook: www.facebook.com/gewrwanda
GEW Rwanda Website (coming soon): www.gewrwanda.org

Eos Visions had the pleasure of hosting Sherri in Rwanda ever since her first visit in 2008 when she joined a medical delegation looking at public health and the consequences of the 1994 genocide and HIV/AIDS on the Rwandan healthcare system. This trip had an enormous impact on her life and, upon returning to the US, she established the non-profit organization One Good Deed for the purpose of implementing medical and nursing education projects in developing countries like Rwanda. Two years ago, she started to present the S.T.A.B.L.E. program to doctors, nurses and nurse midwives at King Faisal Hospital and Gisenyi District Hospital, and to develop further teaching and training opportunities. Since this year, her main focus is on the HBB program.

Newborn mortality accounts for a large proportion of child deaths. More than 40% – over 3 million – of the under-five deaths in 2008 were among newborns according to the WHO. Of these, one million babies die each year from birth asphyxia, the inability to breathe immediately after delivery. The HBB program addresses this challenge and, as such, helps to create progress for the fourth Millennium Development Goal which aims at reducing child mortality by two thirds from 1990 to 2015. It is estimated that 42,000 newborns a year could be saved simply by having a birth attendant dry the baby and stimulate it to breathe.

Sherri’s goal is to contribute to an already impressive progress. Rwanda is one of the countries that is on track of achieving the MDG on child mortality, as the latest MDG Rwanda report indicates. Infant mortality levels, for example, have decreased from 86 out of 1,000 births in 2005 to 62 in 2007/08. Nevertheless, there is still a long way to reach the 2015 objective of only 28 deaths out of 1,000, as the graphic shows.

A variety of Rwandan institutions that range from the Ministry of Health to the Kigali Health Institute and various major hospitals warmly welcome Sherri and her desire to introduce the HBB program in the country. During this latest visit, she had a range of discussions and she also started information and training sessions for nurses and nursing students in different settings. Participants particularly highlighted the multiple benefits of the pictorial-based learning materials including a learner workbook, action plan wall poster, a facilitator flip chart and a realistic newborn simulator with the ability to imitate an umbilical pulse, bag-mask ventilators, and bulb suction that can be cleaned by boiling.

Sherri now returns home with a wealth of suggestions and recommendations that the participants provided when it comes to the Rwandan culture and context. This will help to build an adapted version of the program that had initially been successfully pilot tested in Bangladesh, India, Kenya, Pakistan and Tanzania, and that is now intended to spread to 20 more developing countries. Sherri puts the HBB vision like this: “Master trainers designated in each country will train others, oversee data collection and act as a liaison between the country and the core planning team. New facilitators (birth attendants trained to train others) teach the program to other birth attendants in the community. The idea is not to rely on international trainers to come to Rwanda on a regular basis.”

To get this multiplication effort started, Sherri already plans the next visit to Rwanda, hopefully with a much larger delegation of master trainers. Doctors, nurses and midwives who are interested to possibly join these efforts can find more information at www.helpingbabiesbreathe.org and Sherri’s own website http://onegooddeedkc.org, and contact Sherri at sbrown2126@kc.rr.com. In the words of Gro Harlem Brundtland, the former WHO Director General: “We need to focus more on the most vulnerable children: the newborns. Many conditions that result in a newborn dying can easily be prevented or treated.”

According to Prosper Uwingeli, the Chief Park Warden, “it’s uncommon among the population of gorillas, and very few cases of twins have been documented in the wild or captivity. The twins in Hirwa Group provide another opportunity for comparative research on this rare case of twinning in primates, therefore continuing to get more knowledge and reference for gorilla research, and conservation in general’’.

The two newborns join eleven other baby gorillas that are expected to be given names in the upcoming Gorilla Naming Ceremony scheduled for June this year. They confirm a trend that has been observed over several years already. A 2010 census in the Virunga chain habitat showed a 26.2% population increase of the endangered mountain gorillas, from 380 to 480.

If you are interested in joining the festivities of the Gorilla Naming Ceremony, contact us at info@eos-visions.com.