The Walk Home

Hosting visitors in Rwandan culture is an honor. When you have a guest, you offer him the very best seat in your house, the very best food and/or drink available, and, when it’s time for him to leave, you walk him home. I love this tradition for many reasons. Most importantly, because when I visit people among the many hills and valleys in my community I usually have no idea where I am so I appreciate the guidance back home. 

This custom can, however, create some confusion when you reach home and suddenly visitor is playing host and host visitor… and then we’re walking again in the other direction.  Last week I was party to such a predicament, when after walking my friend home (a thirty-five minute walk uphill) I was invited in to look at photos and take some lemons from the family tree. After the usual series of greetings to family members, neighbors, and curious children, my friend walked me back to our original starting point on the other side of the valley. No wonder Rwandans are so fit!

Culture Moments

Those of you who think I spend my day saving the rainforest while teaching Rwandan baby girls how to create microfinance cooperatives are sorely mistaken. PEACE Corps is first and foremost about friendship and cultural exchange. Volunteers are “ambassadors of peace”, and that is what I work hardest at everyday. Some of my favorite cultural exchange moments so far have included:

•   Michael Jackson’s Black or White. I watched the video in the teacher’s “lounge” at the secondary school on my friend Fulahar’s laptop. Eight of us crowded around the screen and watched the late King of Pop dance on the top of the Eiffel tower and sing with a group of “African tribesmen”. I highly recommend you watch the first minute or two so you can appreciate the irony. Almost five months I’ve been pointing at my skin and the skin of whatever Rwandan is telling me I’m rich because I’m white, saying “cimye!” (same!). Thanks MJ, for the validation.

• Birth Control.  After scanning the register of abandoned birth control appointments, I ask one of the nurses why more people don’t use contraception. “PF is for married women who already have children”, she responded. PF stands for planification familiale, family planning in French. This very politically correct term is unfortunately taken too literally in Rwanda. So, being the former Planned Parenthood volunteer that I am-- I try to explain to my counterpart that women of all ages and marital status should be encouraged to use birth control if they are sexually active. Birth control has many benefits I tell her. Like what? She asks. Well, in America many young, unmarried women use it to help control acne, I respond. Suddenly Mama Eric’s eyes light up: ALMA! YOU SHOULD TAKE BIRTH CONTROL!

• Jehovah’s Witnesses, Part II. On our way to visit a cooking class, my counterpart and I ran into two very well dressed young men walking awkwardly through the hills. Mama Fils greeted them with her familiar warmth, asking about their day and work as if she had known them her whole life. When it was clear that I was confused, she explained to me that they were Jehovah’s Witnesses, and they promptly handed me newsletters in both English and Kinyarwanda. After they left, I told Mama Fils there are also Jehovah’s Witnesses in the United States but people don’t always like them because they come to your house uninvited and want you to change religions To this, she nodded and responded matter-of-factly, “no one here likes them either”.

I get a lot of emails asking me, congratulating me, about my “work”. I am doing (well, more like witnessing) a lot of really fascinating progress at the health center. Still, when I chart a child’s positive growth or correctly show a mother how to sanitize water, I rarely feel satisfied. The 100 grams a malnourished baby gains in a week can be lost in a day, and for all the worms expelled after taking Mebendazole, there are a million more swimming in the water. I am not here “saving the world”, or even my neighborhood. But I am learning a lot, I am teaching a bit, I am greeting and visiting a ton, and I am laughing, everyday with a couple new friends. This is the work I enjoy the most, and feel most satisfied with.

Donath

Donath is just under sixteen months old. He weighs 6.3 kilograms (13.9lbs) and his MUAC (middle upper arm circumference) is 110mm. This makes him a severe, chronically malnourished child. He should be in the hospital. Instead, he is part of the health center’s Outpatient Therapeutic Program I work with every Monday. He has been in and out of OTP for ten months (theoretically, children should be “cured” within six weeks), and his weight has not fluctuated more than 500 grams.

When I first noticed Donath’s lack of weight gain despite the many sachets of Plumpy Nut we gave his mother every week, I mentioned it to my counterpart, Mama Fils. “Yes, he is very sick”, she said. We brought him and his mother into our office and asked her if she would agree to take an HIV/AIDS test. Teary eyed, she agreed. The test came back negative. We counseled her on proper nutrition techniques and hygiene.

Community Health Worker measuring a healthy child's MUAC

Two weeks later, still no change. I mentioned the problem to Mama Fils and again we brought Mama Donath into our office. Between long sighs, quick sobs, and a very shaky voice Mama Donath agreed that she would bring her son to the hospital across the street for intensive care the following day, after she made the necessary preparations. The next day Mama Fils told me Donath would not be coming. “Don’t worry Alma, I talked to his mother,” she assured me after seeing my frustration.

Another three weeks have gone by and on this particular Monday I insist Donath go to the hospital or he could end up dying. So Donath and his mother are back in our office. There are more sobs and head shakings, and this is when I learn why Donath cannot go to the hospital. Donath and his mother live alone, because Donath’s father was a genocide perpetrator and is now in prison.

In Rwanda (and most other countries in Africa) most hospitals provide you a bed and the necessary medications. Patients are generally not admitted unless they come with a family member who will be around to feed, bathe, and generally care for them. If Donath’s mother takes him to the hospital, no one will farm her plots and she will have no food to feed him, so she doesn’t take him to the hospital. Instead, she continues to farm sweet potatoes, and Donath’s body remains too weak and malnourished to absorb any of the nutrients she is able to feed him.

Rwanda is a country making incredible progress on a daily basis. It has been seventeen years since the Rwandan genocide, which means that the children running around my neighborhood were not a part of the horror their parents witnessed. Still, they are far from unaffected.

Move (Again)

I moved again! Luckily this time it has not involved moving continent sub regions, countries, or even provinces. I just moved down the street.

As I mentioned in an earlier post, I moved into a very nice, four-bedroom house, on the health center compound, with four Rwandan roommates and, for a month, another Peace Corps Volunteer. There were a lot of benefits to having company when I got home from work and not having to prepare my own meals, but the truth is that the situation was far from ideal for me for many reasons. The previous volunteer invited the roommates to live in the house for free, which, bottom line, made me very uncomfortable.    

View from my backyard

I have been told the first three months at site are the most challenging. I don’t yet have the rest of my service to compare it to, but I do really hope this is true.

Since arriving in Rwanda, I have had a lot of great moments, but also a lot of unforeseen challenges and frustrations, particularly as they related to my housing situation and the community’s perception of me as a simple clone/continuation of the previous volunteer (only she had perfect Kinyarwanda, I am reminded daily). All of this combined with the evacuation from Niger has, over the last few months, seriously made me doubt my abilities to work and live in Rwanda. 

But now I have a new house, and a new outlook on life! I live a little further away from the health center, in a much more modest house, without electricity, and with lots of wonderful neighbors, including at least a dozen children who run and scream every time they see me coming and are always ready to greet me with toothless smiles and big hugs. And with daily hugs from my five year old friend Valentine, where else in the world would I want to be?!

 

Birthday Celebrations

On June 11^th I celebrated my 23^rd birthday in Rwanda. Thank you all so much for the birthday emails/calls, they really made my day! 

With my coworker, Yvonne

The day was a pretty “normal” Saturday. I taught my weekly English class to the secondary school teachers, I set up my hammock for the first time (thanks Max!!), and in the evening I invited my boss, my new landlord, my former roommate, and my counterpart for a beer.

The highlight of my day, and the best birthday present I received, happened rather casually. I was sitting with my friends at the bar waiting for order, trying to follow the conversation. At one point someone asked me if I understood what was going on, to which I responded honestly, “a little bit”. As usual, this made everyone laugh.

My boss, a man of few words, looked straight at me and quietly, but certainty, said: “by October you will know everything”. The comment was a huge vote of confidence for me. I’ve been struggling a lot with the language because 1) it’s hard, 2) I generally work well when I receive positive reinforcement, not daily reminders of how fluent the previous volunteer was, and 3) the truth is it is possible (not easy) to communicate in Rwanda with only English/French.

The small comment was just the push I needed. Assurance that someone else here believes in me was just the birthday present I was looking for.     

Hearth Program Successes

I successfully helped facilitate my first Positive Deviant/Hearth nutrition course! As I explained in an earlier post, this is the primary project I have taken over from the previous volunteer. She covered about half the villages in the sector, my job is to help cover the villages and enable to health center staff to continue the program without a Peace Corps Volunteer.

The Hearth model consists in identifying mothers in the community with healthy children (positive deviants) and training them to teach mothers with malnourished children how to care for them with local solutions. For twelve days the mothers come together (each contributing different ingredients), to cook nutritious foods and receive daily health lessons.

All in all I would say the program was a success. Personally, I learned a lot throughout the process: about the Hearth model, about malnutrition, and about my community. Perhaps more importantly, ALL the children who participated in the program gained weight! The average was 0.6 kg (1.3 lbs) in two weeks. Incredible!

There were of course several challenges and hold ups, which were frustrating, but I think provided me with great insight for improving the program. The biggest lesson I’m taking away from this course: never assume the obvious. 

Those of you who have had discussions about development know that I am not generally moved by the heartwarming human-interest stories. I like facts and figures. Still, I knew the program had been a success not when I charted the growths; rather, when a woman who had refused to join the course (she said her son was healthy and meeting everyday for two weeks was too much) came to my counterpart, Mama Fils, asking when she could join the next Hearth class. She saw the improvement in her neighbor’s children and wanted the same for her son.

 

Hearth Program Challenges

I will preface this post by saying that it is extremely critical (and long), mostly because I believe the project I am working on has enormous potential. I can be an awfully opinionated and critical person at times, and this is one of those times. However, I feel incredibly lucky to be working with the Hearth model and I have tremendous respect for PCV who lived here before me, and the work she did. Having said that… 

One of the incredible things about the Positive Deviant/Hearth model is that it requires very little funding. Peace Corps Volunteers should be able to conduct a Hearth course without having to fill out any grant proposals or ask for outside resources. Generally, Peace Corps projects rely on partnership with the community. The best projects come from initiatives made by local stakeholders, who have the most invested in the project’s success, with PCVs acting simply as facilitators. 

At my health center, Peace Corps provided an enormous one-time grant for this project. In the words of my former roommate, the health center accountant (who is considered by people in my community to be rich), funding for the Hearth Project was “more money than she had seen in her entire life”.

The money was used to buy some durable goods (notebooks, pens, cooking pots), lots of ingredients for cooking (corn flour, soy flour, dried fish, oil), take-away’s for Hearth participants (soap, chlorine, live chickens) and lots, lots of per diems. Money for the project is now gone—all spent. Left are ingredients for the cooking classes and staff members who are expecting to get paid.

Now you might be thinking to yourself, Alma, you are a heartless ice queen. Are you turning into a republican? Since when did you become so fiscally conservative? You live in a country where annual per capita income is $290 and the poverty rate is 64%, what could possibly be wrong with providing extra cash flow? The answer is quite a few things.

Let me just briefly comment (ok, let me complain about) the ridiculous number of Western NGOs dropping all sorts of materials, projects and cash in Rwanda and then leaving. I’m not saying these organizations are bad or that I know better, I’m just saying it makes my job (and explaining my job) a lot harder. Dependency on foreign assistance in Rwanda, particularly in the health sector, is enormous. This is not what Peace Corps Volunteers are supposed to do. Unfortunately, the Hearth Project, bringing in such an incredible amount of money, has rather distorted the perception of Peace Corps and the PCV in my community. 

I discussed the issue of per diems in a previous blog post. With the former volunteer, every time someone in the community helped with the Heart Project they received daily per diem. Providing per diem when there is all weekend training makes sense. Paying the nutritionist per diem to weigh children in the community (i.e., her job) does not. The expectation that I would continue providing per diem has been challenging and very frustrating to break. Not only do my coworkers see no incentive to work on the project; but also I am once again seen as inferior to the previous volunteer because she gave them money and I do not.

Luckily, my counterpart is an incredible woman who cares about the children in her community. After lots of grunting and eye rolling, we settled on me buying her a drink and brochettes (delicious barbequed goat meat) at the beginning and end of each Hearth course.  

The fundamental problem with providing so much to the Hearth Project, however, is that by giving almost all the cooking supplies to mothers (not to mention the chickens), the core objective of the course is defeated. Oil, soy flour, and dried fish are available locally, but more expensive than the beans and nutrition-less sweet potatoes that poor families feed their children everyday. By requiring mothers to bring ingredients to the class, parents realize that they are able to provide for themselves and that the slightly higher cost is worth it when their children are healthy. When I provide the ingredients, mothers understand what foods help their children grow but still think it’s impossible to do without assistance.

These are issues I am working on. For starters, my counterpart and I are going back to the villages where Hearth classes have already been conducted (some already a whole year back) and seeing whether or not mothers have retained the information learned and children are healthy. Through monitoring and evaluation I hope to help my counterpart and other health staff members understand the downfalls of simple handouts and the importance of sustainability. Stay tuned!

Jeannette, who began the Hearth Program crying every time
she saw me and ended up my best friend