Women in Rwanda

The Washington Post has published interesting articles recently about the role of women in Rwanda as politicians and business owners.





"Women Run the Show In a Recovering Rwanda"- October 27, 2008
http://www.washingtonpost.com/wp-dyn/content/article/2008/10/26/AR2008102602197.html?sid=ST2008051504314&s_pos=list

and

"Women Rise in Rwanda's Economic Revival"- May 16, 2008
http://www.washingtonpost.com/wp-dyn/content/story/2008/05/15/ST2008051504314.html?sid=ST2008051504314&s_pos=list

PEPFAR II: Big Picture

Background
In May 2003, Congress approved and President Bush signed into law, the "United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003" This legislation approved expenditure of up to $15 billion over 5 years.The program known as the President's Emergency Plan for AIDS Relief (PEPFAR) spent $18.5 billion over those five years to prevent HIV infection, treat people with AIDS, and provide care to orphans and vulnerable children. PEPFAR is "the largest commitment by any nation to combat a single disease in human history."

Moving Forward

On July 30th , 2008 the U.S. Government reauthorized the President's Emergency Plan for AIDS Relief (PEPFAR) allocating $48 billion to developing countries for their struggle against AIDS, tuberculosis and malaria. The bulk of this money, $39 billion, is for HIV/AIDS, with $4 billion going towards tuberculosis, and $5 billion for tackling malaria. The act also doubles the US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria to $2 billion yearly.

The 2008 reauthorization act provided the following guidelines:

• Over half of the funds are to be spent on treatment programmes, including antiretroviral treatment, care for associated opportunistic infections and nutritional support for people living with HIV/AIDS.


• In countries with generalised HIV epidemics, at least half of all money directed towards preventing sexual HIV transmission should be for ‘activities promoting abstinence, delay of sexual debut, monogamy, fidelity, and partner reduction’. If this is not complied with then the Global AIDS Coordinator must report to Congress within 30 days on the reasons behind the shortfall.


• 10% of the funds are directed towards helping orphans and vulnerable children.
  

PROS

The U.S. is saving the lives of millions of people in the poorest places on the planet through this effort. The number of AIDS deaths worldwide dropped 10% in 2007 due to increasing access to treatment, as did the number of new infections in children. “In a surprisingly short period of time, there has been a tripling of prevention efforts in some countries,” said Dr. Paul De Lay, director of evaluation for UNAIDS.

PEPFAR reauthorization was the result of months of work by Democratic and Republican congressional leaders, advocacy organizations, foreign policy experts and medical professionals who worked together to pass historic new funding levels to fight AIDS, TB and malaria.

Bipartisan Support: McCain and Obama were co-sponsors on the the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008. (headed by Sen. Biden and Lugar and others)

PEPFAR II rescinded the United States HIV/AIDS travel and immigration ban, which as one consequence had prevented the US from ever hosting HIV/AIDS conferences, and even worse discouraged HIV-positive immigrants, many of whom acquired the disease in the US, from taking an AIDS test or accessing medical services.

"America’s global AIDS plan has proved to be a smart investment, paying dividends in lives saved, communities stabilized and America’s reputation in the world growing a little bit brighter. This stuff works and leaders from left and right — leaders like Senators Biden and Lugar, Representatives Berman and Ros-Lehtinen, President Bush, Speaker Pelosi and Senator Reid - put aside their differences and agreed to do more." Bono- co-founder of the One organization. 7/31/08

CONS

PEPFAR continues to require beneficiary countries to emphasize abstinence-only in their prevention efforts, a methodology supported by religious ideology, not scientific evidence.
At times this means countries have had to use essential funds in ineffective ways.

PEPFAR has a "conscience clause" allowing HIV/AIDS workers to deny services to anyone they deem "immoral." This U.S. foreign policy often promotes both stigma and discrimination against homosexuals, intravenous drug users and sex workers ironically, among those most at risk of HIV/AIDS.

A recent study in six U.S. urban centers revealed an astounding HIV prevalence of 46 percent among black gay men. In addition, the U.S. Centers for Disease Control and Prevention released its revised estimate for annual new HIV infections in the United States, a 40 percent increase, from 40,000 a year to more than 56,000. It seems possible that we have grossly underestimated the scope of the national U.S. epidemic in the past decade.

PEPFAR requires beneficiary nations to develop a national AIDS strategy, while the Bush administration has refused to create one of its own. However, Congress has just allocated $1.4 million to launch a national strategy.

Rwanda has been ahead of the curve in meeting treatment goals, but they and many of the other focus countries struggle with the following challenges:

• coordination difficulties amongst both U.S. and non U.S. agencies
  
• U.S. government policy constraints


• shortages of qualified focus country health workers


• focus country government restraints


• weak infrastructure, including data collection and reporting systems, and drug supply systems.

For more information: A report from the Kaiser Family Foundation compares PEPFAR I with PEPFAR II here.

Why not eat the monkeys?

Stories from Rwanda pop out in conversation with me all the time. Many of them are thought provoking- like this one...

During my last week in Rwanda, I ate lunch with some of my Rwandese friends on the CDC team. They asked a lot of questions about what is different in D.C. as compared with Rwanda. I joked about how lunch at NIH is not a buffet (luckily!) and how there are not usually toothpicks on tables (which is common practice in Rwanda- maybe because the meat is tougher?). One of my friends, "A", told us he had been to Washington DC a few years ago. He had never been to the States before and stayed there for four days while in training. Here is one of the many compelling things he had to say:

A: There are many traffic circles in D.C. like Kigali.
Me: True! And similar crazy driving and lack of traffic rules in both cities.

A: In D.C. there are a lot of monkeys living in these circles.
Me: What! Did you say monkeys?
A: Yes, a very small kind with long furry tails and little hands breaking apart thier food.
Me: Oh you mean squirrels!
The group : What is a squirrel?
Me: Uhmm...rodent family I think, like rats...not monkeys.
(Laughter)

A: Also, there are a lot of people living in the circles.
The group: What! There are houses in the circles?
A: No, they sleep on the ground and cover themselves with plastic.
The group: Why? (looking to me) Is there no space for houses in the US?
Me: No, we have plenty of space for houses.
The group: Well, is there not enough building materials?
Me: No, we have plenty of materials.
The group: How do they cook food? Do they eat the monkeys?

I stumbled through an attempt to describe how and why homelessness exists in the US. I conveyed that life can get very complicated (especially in a larger city in the US) in terms of buying or renting a house/car/utilities/etc. and we have to navigate these complex systems which require a stable income. When this isn't possible, losing your house/car/etc can happen very quickly. I mentioned how some people suffer from disabilities or physical and health ailments and are unable to navigate and function in these systems. They may not have or be near family members who could help. I also mentioned post-traumatic stress from fighting in a war; natural disasters destroying homes; shifts in skill sets needed among workers; and the impact of policies/politics on government services available to adults.

In Rwanda, there are essentially no adults without a place to stay. When you do not have money to pay for a house, as a last resort you go to the forest, cut down some trees, get some mud, and make a home. And before that option, there is an open door policy among families and friends-who-are-like-family. It is understood that you can just show up to stay with them if needed. They place a high value on "families" and cast a wide net defining their family members. In my short time there I received the warmth of many friends considering me to be part of their "family", and telling me that next time I come to Rwanda I need to stay with them.

All good things come to an end

Once again my visit to Rwanda has ended (way too short this time!) In my last few days I was able to shop for souvenirs and say goodbye to many friends.

Mahita and I went to the "Gahaya Links" wharehouse- a company in Rwanda that distributes woven baskets to Macy's. We were able to purchase some of the "extra" merchandise and see some of the newest designs.

This is the owner, Joy. She posed wearing a new proto-type of a woven necklace. It is very pretty and I told her it is sure to be a bestseller (at least I want to buy one when they are ready).
I will miss the beutiful hillside in Rwanda and walking to work in the perfect weather everyday.
I gathered friends and colleagues on Friday night for dinner at the Cactus restaurant which serves my favorite fish brochettes. This has also become a tradition because I had dinner there on my last night during my previous visit to Rwanda.

This is David, a CDC colleague in charge of laboratory technical partnerships and projects.
Many of the usual suspects joined me...Noni, Josh, Kris, Mahita.
As well as my new friends, Morgan and moses.

Cactus is located down the street from a popular ex-pat neighborhood where some of my friends live so they come here regularly. Noni ordered some fried cheese triangles and Josh ate avocado salad (the avocados are huge in Rwanda).
Here is my favorite fish brochette in Kigali (grilled tilapia, onions, tomatoes, rice, and salad).

Others really love the pizza here.
Patrick's cousins Calissa and Moses joined us for dinner.
We went to Legends after dinner and listened to Congolese music.

On Saturday before my flight, Morgan hosted a tacos and margaritas afternoon party. It was a perfect activity before leaving Rwanda. Morgan has been house-sitting for another US Government employee who has been on leave, so she took this opportunity to cook and have people over.
Her house, like most houses in Kigali has a beautiful view of the city.

Morgan even had salt for the glasses. Bueno!


I promised my friend Moses that I would take a picture of these mini-bananas that I packed in my suitcase (even though I don't think I was supposed to bring fruit into the US). We are considering how we might export these bananas in Rwanda; they are sweet and the perfect size. They stayed pretty green in my luggage... maybe it is possible to export them to the US. :)

Good times in Gisenyi

Morgan and I took a "matatu" (swahili word for taxi; refers to public transportation mini-buses in many African countries) to Gisenyi on the shore of Lake Kivu in the West Province of Rwanda, near the border with Goma. The bus is one of the cheapest ways to travel in Rwanda- this trip only cost $5 for the three-hour journey. Gisenyi is near Mount Nyiragongo in Congo which has erupted many times including a very destructive eruption in 2002 and a small eruption most recently in 2007. Some of the highlights of Gisenyi include the Serena Resort hotel on the beach, the Brawilra (only brewery in Rwanda), hot springs, and an orphanage founded by the late Rosalind Carr.

Morgan lived in Gisenyi for 6 months a couple of years ago so it was fun to roam around the city with a semi-local friend!

We took many pictures of the scenery out of the window. The Rwandans on the bus were very friendly. We held babies, practiced speaking Kinyarwanda and french, and laughed at the country music tape the driver played (which of course included Kenny Rogers, The Gambler).

There are signs like this one below in and around the Gisenyi town which indicate the eruption threat level for the volcano. Yellow seemed like a good sign to us, although we couldn't read the information since it is written in Kinyarwanda. We wondered how often someone comes to check and change the flag if necessary?

We stayed at the Hotel Belvedere. It opened in the last few months, and Morgan happened to see it being built when she last visited. It is very nice and we don't think many people know about it yet. It is situated at the top of a hill above Gisenyi, so our weekend involved quite a bit of walking up and down the hill, and one or two interesting moto taxi rides!

Our room cost 45,000 francs for the night (about $90), although we learned there is a cheaper room that costs $50 which has a smaller bathroom but was mysteriously unavailable for our night even though the hotel was mostly empty. We're pretty sure they just wanted to give us the more expensive room! Oh well, live and learn.

We had a pretty fantastic view of the lake from our balcony as well as the upper hills behind the hotel.

Breakfast on the terrace was included with the room. I ordered an omelette, which unfortunately came drenched in butter so I filled up on the delicious tropical fruit and coffee instead!

Almost everyday for breakfast I eat passion fruit, mango, and these sour but yummy tree tomatoes.

As we walked through town we noticed these funny topiaries shaped like the traditional Rwanda baskets.

We met up with Morgan's friend Fred who is so nice and fun.

We spent some time relaxing on the beach at the Serena Hotel.

Morgan discovered floating lava in the lake, which she was glad was not a floating head as she had thought.
We stopped at a small local restaurant and ate goat brochettes (grilled goat and onions on a stick) which were really yummy. Although Morgan mentioned she had once heard a goat being slaughtered here. Luckily that didn't happen today, otherwise I might have become a vegetarian! We also drank the locally brewed Mutzig beer.
We stopped by a small kiosk/store where a friend of Morgan works.

She used to stop here everyday after work to get an informal lesson speaking Kinyarwanda with her friends. They were very happy to see her again, and happy to spend some time teaching me too!


Of course, I couldn't take a weekend trip without buying some more Rwandan and Congolese handicrafts for my growing collection.

Pub adventures and birthday celebrations

I visited my friend Laurie at the British Embassy on Thursday. They know what is most important- they have a pub that is open on Thursdays and run by Embassy staff.
We played a pub game called Toad, where you try to throw coins into a box.
The name of the pub is the Goat & Gorilla.

I also celebrated Laurie's birthday at a local restaurant called Papyrus earlier in the week, and met many of her friends.

Laurie received some fun birthday presents. Including this musical instrument from the Dominican Republic.

I ate pizza de poisson. If you are thinking that fish does not really go on a pizza...you are right. The pizza sauce and crust was great, but the fish was not such a good idea!

And also some pictures from an earlier dinner at another local restaurant called Republica last week...

Rakhee and I (they brought us blankets because it got chilly!)

Marie Claire and I