Category: Africa

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“Imihigo” and Reasons for Successful HIV Management in Rwanda

By Liz Lin

On April 2nd, 2014, Dr. Jean Luc Nkurikiyimfura presented his experience as the Director of the HIV Clinic at Kigali University Teaching Hospital or CHUK (Centre Hospitalier et Universitaire de Kigali), explaining the strong positive trends the country was experiencing with regards to HIV/AIDs management. Specifically, he explains the success with committed leadership, a network of community health workers, and partnerships with international groups.

Rwanda is a small country in central Africa, about the size of New Hampshire with ten times the population. It is also a poor country with a GDP ranked 203 out of 227 countries. Dr. Nkurikiyimfura points out that for a population 11 million, health professionals are scarce: there are only 625 MDs, 8273 RNs, and 240 midwives. Yet, Rwanda has come a long way in providing for its people.

The devastating effects of civil war and genocide in the 1990s, with rates reaching 1 million Tutsi and sympathetic Hutu people slaughtered by Hutu majority in 3 months, can be further quantified by a life expectancy of 28 years in 1994. Dr. Nkurikiyimfura, going back to his home at the end of the decade, recalls the country smelling of death, with corpses still strewn about the land. Since then, the life expectancy has steadily improved to 53 years alongside a 86% reduction of malaria related death. More strikingly, 5-year mortality after birth has decreased from 186 to less than 50 per 100,000 births, not only reaching pre-genocide levels, but also reaching rates lower than the average in Sub-Saharan Africa.

Dr. Nkurikiyimfura’s HIV clinic has also had remarkable success in providing access and treatment for HIV/AIDs patients in all aspects from diagnosis, treatment, to follow-through. Prophylactic measures reduced the incidence of HIV vertical transmission, and in 2012 less than 2% of newborns had the virus compared to 11.6% in 2005. With a target demographic of children and adolescents, the clinic also educates for community change from within. Dr. Nkurikiyimfura attributes the success due to the committed leadership, citing the government to be the “least corrupt” compared to surrounding countries and effective in allocation of resources. The community-based focus, with community health workers placing an emphasis on maternal care and child health, and a triage-like system in treatment, builds a strong foundation for public health. Furthermore, community health workers create a network of personal contact to help with treatment adherence through organization of group support and home visits. Finally, the international support, especially from NGOs, is critical.

Some reasons for success may prove to be challenges in the future, speaking to the multi-faceted nature of global health. International support is the least sustainable in the long run, though critical for now. Understandably, with the poverty of the country,Dr. Nkurikiyimfura estimates 80% of the allocated money to fight HIV comes from outside sources. Right now, Rwanda has been justifying the investment, for example, from the Global Fund, with numbers. However, the long term success of combating HIV in Rwanda depends on change from within. Taking communities into context for the treatment of disease is essential: the health care structure must come from the community and not be imposed based on what outsiders might think may work. “Imihigo,” a term defining a pledge to achieve for communal good, is a concept with traditional roots. Dr. Nkurikiyimfura states traditional concepts, including “imihigo,” are key for sustainable development and continued momentum from the Rwandan people

By showing relevance and results through numbers, fighting HIV in Rwanda is a success story. A government committed to forming a strong health care system proves to NGOs and funding sources that it is committed to succeed and builds a partnership of trust in receiving the financial resources needed to effect change. The Rwandan people, pledging “imihigo,” have a strong stake to help themselves and is creating a sustainable network of community health workers and educated citizens.

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West African Cuisine

By Jane Zhang

Last Saturday night, I sneaked into the West African Cuisine class in McCulloch International Residence, taught by the lovely Baaba. I thought I stumbled into food heaven. I looked inside their trash can, and I have to say, I was impressed—plantain peels, burnt rice, yam skins. Baaba, who is from Ghana, though has lived in the U.S. for a while, was teaching peers to make spinach stew.

Spinach stew consists of a primary ingredient that, excuse my ignorance, I had never heard of before: palm oil. Palm oil is actually widely used for cooking in West Africa, Southeast Asia, and Brazil. For cooking enthusiasts, the rest of the ingredients were bouillon cubes, tomato paste, diced onions, diced green pepper, diced garlic, and smoked turkey.
While the stew was simmering, students in the class patiently peeled plantains and yams using knives. The plantains and yams were cooked in water and salt.
Then, mushrooms and spinach were heated in a pot before combining with the rest of the stew.
Other students opened containers, happy to discover that the leftovers smelled just as good. I had never seen so much food in a dorm kitchen at Dartmouth before. My mouth was watering from just looking at all of the food scattered throughout the kitchen. Such a gluttonous person as me really shouldn’t be covering food events.
Overall, it was a wonderfully lighthearted atmosphere. We drank Malta Goya, though I wasn’t such a big fan of the syrupy texture. Unfortunately, I had to leave before the food was ready, but I’m sure everyone who stuck around got to eat several helpings and go home with new recipes and plenty of leftovers!

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Gender Inequality and the Arab Uprisings

By Nick Donlan

When discussing and analyzing the events of the last eighteen months in the Middle East and North Africa, many commentators have framed their narratives and explanations around the “heroic martyrdom” of Mohamed Bouazizi, the Tunisian street vendor who famously set himself on fire after having his wares confiscated by a local police officer. Although his act and story became a catalyst for the Tunisian Revolution (and, some argue, the ongoing uprisings throughout the region), the conventional media account of the incident tends to omit how Bouazizi’s self-immolation may have been the product of more than simply the economic injustices he experienced. While Bouazizi’s difficulties finding a suitable job have been well-documented, pundits frequently overlook (or disregard) his own family’s suggestion that his suicide may have been a response to the shame and humiliation he felt after being slapped in public by a female government official. The world will never know exactly what motivated Bouazizi to strike that fateful match, but his family’s speculation should serve as a reminder to those attempting to comprehend the Arab uprisings that issues of gender inequality are inextricably linked to concerns about economic opportunity and political participation.

In the wake of Bouazizi’s death, specific circumstances and motivations aside, public dissatisfaction with the actions and policies of authoritarian dictators gave way to the rise of widespread protests throughout Tunisia, Egypt, Libya, Bahrain, Syria, Yemen, and beyond. Over a year after these protests began, the region’s governments continue to scramble to consolidate power and regain — or establish — legitimacy with their citizens as they face increasingly uncertain futures. However, the plights of these regimes pale in comparison to those of women throughout the region, many of whom played unprecedented and often vital roles organizing and participating in demonstrations. Although nascent democracies have emerged in Egypt, Libya, and Tunisia, early evidence seems to suggest there are no guarantees that more citizen representation will translate into more beneficial outcomes for the women of these countries.

In the most recent issue of Foreign Policy, Mona Eltahawy argues convincingly that the political changes have done little for women across the Middle East and North Africa because of deeply rooted patriarchal attitudes that hamper the prospects for sweeping social changes. In Egypt, for example, women turned out to the streets after the fall of Hosni Mubarak to celebrate International Women’s Day only to be harassed by a rival protest of men spouting insults like, “Go home, wash clothes,” and, “You are not married, go and find a husband.” With just eight women in Egypt’s new 500-seat parliament dominated by the Muslim Brotherhood and the Salafists, practices like forced marriage and female genital mutilation may remain part of the status quo for the foreseeable future. Perhaps even more troubling are the signs of backsliding in traditionally tolerant Tunisia; several female university professors and students have voiced concerns over Islamists’ open hostility towards them for not wearing hijabs.

The awarding of the Nobel Peace Prize to Yemeni activist Tawakel Karman marked an important moment of international recognition of the bravery of an Arab woman. However, despite this recognition, Karman still endures criticism from fellow Yemenis who have labeled her leadership style as “dictatorial” and accuse her of ruining the morality of women. Until men and women present a united front against repressive governments, these revolutions will fall well short of their potential to remedy not only gender discrimination, but also other social and economic ills. Indeed, as Eltahawy eloquently put it in her piece: “The Arab uprisings may have been sparked by an Arab man … but they will be finished by Arab women.”