Category: Rwanda

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“The Game Changer” – Madeleine Albright on Russia and Crimea, Syria and the Future of US Foreign Policy

By Bryan Thomson

On April 8th, 2014, Secretary of State for the Clinton administration Madeleine Albright met Director of the Dickey Center Ambassador Daniel Benjamin to discuss her experiences in Spaulding Auditorium. After giving a glowing introduction for Secretary of State Albright, the first woman to ever hold the office, Ambassador Benjamin jumped into perhaps the most pressing issue in current global affairs – Crimea.

Secretary Albright described the situation in the Crimean peninsula as a “game changer.”  Despite efforts to cooperate with Putin and Russia after the collapse of the USSR, Russia has become consistently more hostile to America and Europe since the turn of the century. Hostilities recently culminated in the well-publicized seizure of Crimea from Ukraine. Secretary Albright, speaking as a Soviet expert, asserted that post-superpower Russia has “psychologically lost its identity” and now disappointingly sees a free Europe as inherently anti-Russian. Accordingly, Secretary Albright contends that the West must be prepared to develop multilateral sanctions to show Putin that use of force over diplomacy isn’t tolerated in the present international system.

When asked about her own involvement in the region, Secretary Albright defended the Clinton administration’s NATO expansion, which many are now calling into question. She cited Article 5 of the NATO treaty – an attack on one member is an attack on all – as a critical deterrent to Russian aggression.  Dismissing claims that NATO acted like a charitable organization, Secretary Albright claimed the organization’s strategic mission has changed since the end of the Cold War. Now, NATO has found allies in many nations previously swallowed unwillingly into the Warsaw pact. Poland, Latvia and others, who have chosen to join NATO have not seen similar violations of their borders as has Ukraine (whose request to join was denied in 2008).

Secretary Albright also made some very straightforward comments regarding Syria. Drawing a parallel to Bosnia, Secretary Albright reminded the audience of the responsibility to protect Syrians.  When asked by an audience member about concrete actions she wished to see the US currently taking, Secretary Albright stated that the US should increase humanitarian and medical assistance to Syrian civilians, especially given the horrific reemerging cases of polio in the region.  She warned that “We are going to be asked why we didn’t do something about Syria. Not 20 years from now, but one year from now.” Unlike the confusing reports and breakneck speed of atrocities in Rwanda, Syria presents an ongoing rights violation that Secretary Albright believes the US should act on immediately.

Secretary Albright, who escaped both fascism and communism in her home country of Czechoslovakia to become one of the most influential and groundbreaking stateswomen in America, elicited a laugh from the audience when she claimed she is “an optimist who worries a lot.” True to her statement, the 90-minute conversation between Secretary Albright and Ambassador Benjamin ultimately proved the former Secretary of State to be cautiously optimistic about America’s future. Drawing on her own work across the aisle with Senator Helms (R-NC), she hopes that current Republicans and Democrats in the center will come together and make progress (or, in her own assured quip, “regain some civility and get some things done!”).  Despite recent inauspicious news, she maintains that a brokered two-state solution is possible in Israel, and that progress with Russia as a partner is still obtainable.  Though Madeleine Albright warned that the challenges of today make those in the ‘90s pale in comparison, her cautious endorsement of both America’s and the world’s capability to progress invites confidence and hope in the future.

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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.