If there hadn’t been a gigantic sign on the street saying “C.E.L.P.A.R. Polyclinique”, the house within which it resides would have been indistinguishable from the other small dwellings crammed side by side along the road in East Kigali, the capital of Rwanda. We had only driven for about 15 minutes from central Kigali and it was like night and day. The French spelling for the center is a result of the association Rwanda had with Belgian after they were colonized in the last century and the close connection they maintained with France, until the last decade. They are now focusing on English as their second language of choice and teaching it in place of French in the schools.
There was a crowd of people waiting for us on the street and others quickly joined, as they saw a mini-bus of muzungas (white people) stepping foot in their neighborhood, an area of town seldom visited by foreigners or aid agencies. It took us several minutes to say our hellos, take the obligatory photos of children and show them their image in the camera (to their unquenchable delight) and head towards the sounds of music we were hearing from somewhere in the near distance. Someone standing next to me said she was hearing the sound of angels and kept looking up, even though she wasn’t religious in the least. We soon discovered where the heavenly music was coming from.
The clinic’s doctor, Fred Ndatimana, led us over the ditch on a slanted path up to the entrance where we were warmly greeted by the director, Abel Sekabarati, his assistant, Fabien Musabyinana, the nurse, Ndayifluga Bizinana and a choir of patients (men, women and children) singing their hearts out. Some of them were sitting (too tired or sick to stand) and the rest were swaying side to side clapping their hands and looking upward as they harmonized. There was one older woman with a baby in her arms that immediately caught my attention. They looked like an African version of a cover from The Saturday Evening Post and had that Norman Rockwell vibe, even though their reality was far from idealistic or serene.
In the last ten years, Rwanda got a jump start on HIV education and treatment with a comprehensive array of support from the President’s wife, Mrs. Jeannette Kagame, multiple governmental organizations and national health plans, as well as funding from numerous international aid agencies and foundations. Mrs. Kagame has gone beyond the efforts of most governments in other countries to address the AIDS pandemic, let alone as First Lady. In 2001, she hosted the African First Ladies at the Kigali Summit on Children and HIV/AIDS Prevention gathering, which was the first of its kind. This meeting provided recommendations and suggestions that each First Lady in attendance would implement in their own region and country. Mrs. Kagame developed a national plan of action for Rwanda, which catalyzed the creation of PACFA, which means Protection and Care of Families against HIV/AIDS. Another program that has been somewhat successful is called Unite for Children, Unite Against Aids. The health department has this campaign in all the provinces. Its priority is making treatment and testing available to all children, as young as possible.
My friend Wendy Leonard, who is the director of an AIDS education and health treatment organization in Rwanda, called The Ihangane Project, was in a small town (Ruli) in the northern part of Rwanda four years ago, working as a physician with a program connected to the Clinton Foundation. She discovered that one of the most challenging issues was making sure everyone was getting the same information and protocols from the various government offices, committees, NGO’s and countrywide initiatives. She also found that the best way to connect with adults was to first focus on and get treatment for their children, thus the importance of programs like Unite for Children, Unite Against Aids. She concurs that there has been a lot of progress, but that much remains to be accomplished.
Though these programs and policies have made great strides, they have not completely reached small community clinics such as C.E.L.P.A.R.’s Polyclinique, which is overseen by a local church organization and gets by on pins and needles, literally. There supplies are minimal, medical staff scarce and funding almost non-existent. In spite of these realities they have hope, education and community support beyond the expected.
As the singing and dancing continued, we were led by Dr. Ndatimana through the facility, which consisted of a small room containing the lab equipment (a few items for testing blood, including an old hand crank egg beater turned upside down (which was used as a centrifuge), two brightly painted “sick rooms”, a toilet closet and the front living room, from which we had entered. Their medicine cabinet, in the same room as the “lab”, contained about 30 medications (antibiotics, Tylenol and a few antiviral meds). That was the extent of their high technology laboratory and pharmacy; a far cry from the equipment at the hospital. There are 2 hospitals in Kigali. One is public and the other private. There are also numerous health clinics run by government and religious organizations and departments.
Dr. Ndatimana filled us in on the details. “We have two doctors. One is here and the other is in school in Belgium.” There is only one medical school in Rwanda, which is of course a very expensive expenditure. “We see many people that are HIV positive and others with AIDS,” the doctor continued. “The government helps a lot, but it can take a long time to see a doctor or get treatment at the hospital. We help them here through the church. The medicine is from the government, who pays for the drugs. If people have good support they can live for 15 years or longer, if not, they usually die within 2 years. This is an outpatient clinic, but sometimes if they are real sick they stay overnight in 1 of our 2 beds.” The doctor couldn’t recall exactly how many people had died from AIDS over the years and didn’t want to guess. He said, “It is sad, but it is part of my job. I’m a doctor”.
Even with the help of the clinic, fellow patients, the church and the government, it is unlikely that many people have the “good support” which Dr. Ndatimana speaks of as a necessity of living longer, since the country (and surviving family members) is still struggling to regroup after the shattering 1994 genocide. Many families were decimated, leaving few relatives or next of kin, let alone the financial or material whereabouts to recover. Top that off with the thousands upon thousands of orphaned children and you have an overwhelming, though not insurmountable, landscape of suffering and struggle.
When asked about the attitude of Rwandans’ towards those with HIV and AIDS, Dr. Ndatimana said, “Many organizations have worked on educating people about the disease. Now they are treated just like friends, like any other sickness. They are not stigmatized as they once were. Now they know we care. We have a team of counselors that help talk with people and teach them to not be afraid.” Mr. Sekabarati (the director) added, “We help them here through the church. “These people are our neighbors and from different churches. We want to help them, not condemn them.”
People were not always so understanding in the 80’s and 90’s. A lot of misinformation, fear and ignorance surrounded the disease and those that had it. Like most places in the world (West and East), it has taken an armada of consistent and persistent educational, governmental, health care and religious leaders to get the truth out about HIV and transform the cultures attitude from judgment to concern and support.
The fight is far from over. After another “awareness campaign” to reduce the spread of HIV, it was reported that there is still a low rate of condom use in remote areas of the country. They believe this is due to remaining stigma and lack of access to supplies. Rwanda imports about 14 million condoms per year, but that supply doesn’t meet the demand, especially in small villages outside the capital. These realities have driven the National HIV/AIDS Control Commission to increase imports for the demand and continue the Witegereza campaign, whose message is “Teach Me How To Use a Condom”. This campaign combines radio ads and over 200 billboards throughout the country. It is targeted at young people and adults.
The staff at C.E.L.P.A.R.S. Polyclinique state that all of the government programs, such as United for Children, Unite Against Aids, PACFA and Teach Me How, have made a difference, but it is neighbor to neighbor that works best. “When someone you know and have known for years, is sick, you want to help, says Mr. Sekabarati. “As Christians we are taught to love our neighbor as ourselves. It is the right thing to do. We are not here to judge others. Anyone can get sick; it doesn’t make you a bad person.” C.E.L.P.A.R.S. has been educating people door to door, during sermons, at social events and from the example of their pastors and church elders, who not only support the clinic, but helped set it up in the first place, when they saw that not everyone’s needs were getting met.
Before leaving the clinic I spoke through a translator with one of the women singing. She said, in her birth language of Kinyarwanda, “We all support each other and are starting to understand.” She stated that patients help each other and check in on one another’s families throughout the week. They’ve developed a support system of those that are HIV positive and are not shunned, as they were in the past. Her words reminded me of one of the teachers at the ROP Center for Street Children, the orphanage in which we had been working for a number of weeks.
The teacher that came to mind was a woman who is Hutu, but is now teaching children who come from predominantly Tutsi backgrounds. Her husband is in jail for committing atrocities during the genocide (perhaps even against some of the parents of the orphans his wife now teaches). The teacher is HIV positive, as a result of transmission by her husband, as is their child. She continues to teach and love the children at ROP, while also visiting her husband in prison. In the past, she would have been ostracized and shunned for her illness or tribal affiliation, but now she is accepted and speaks of it freely. Her life embodies the contradictions, traumas, circumstances, transformations and ever-present hope, mixed with realistic and pragmatic solutions, which encompass the lives of most Rwandans.
After our tour was ended, we sat on a wooden bench or leaned against the wall and listened to some more songs. I don’t know how many people were not feeling well that day or had been sick for some time or how many folks in that small room had already lost family members, relatives and friends to AIDS, but the energy that radiated from their hearts and voices, seemed to transcend their circumstances. It was as if they were telling illness and death that they had no hold on them and were powerless in their presence. Children were laughing and playing outside the door, peering in, giggling and smiling before dashing off to play hide and seek. Adults entered and left quietly or stayed and joined in the singing. Dr. Ndatimana translated a verse from the last song. “We might have AIDS,” they sang, “but no matter how sick we are, it doesn’t matter. By the time we get to heaven we won’t be sick any more.” They weren’t being fatalistic. It didn’t mean they would stop taking medicine, educating others or desiring to live into old age. They were at peace with what was and what would be. Although I doubt they have ever heard of Alcoholics Anonymous or 12-step programs, they seemed to have down the serenity prayer by heart and not just in their heads. The prayer says, “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”
As we made our way back to the ROP Center for Street Children, we discussed the clinic and the experience. We tried to make sure that we cut short our tendencies to compare health care and HIV prevention and treatment in Rwanda with our experience back home in The States or Europe, but couldn’t resist. Some of us on the team, who had come to work at the orphanage, have also worked in the fight against HIV/AIDS in the West and dealt with the bureaucracy, setbacks, prejudice and fear that held sway in the early days of the pandemic and continue, to some degree, into the present. We were saddened by the lack of material provisions at the clinic, but also gratified by the community understanding and support. What impressed us most was the incredible dedication and lack of self-righteousness by the church, especially since it was a fundamentally conservative evangelical organization. They were actually matching their religious rhetoric with their actions. They were giving time, money and most importantly, a human touch to their faith. It was such a divergence from what we were used to with similar “Christian” bodies in the west. We were intimately familiar with people professing to be Christians, but whose rhetoric was hateful and only caused separation and pain and fanned the armies of ignorance. It was so refreshing to speak with the pastors and board of C.E.L.P.A.R.S. Some of us even began reconsidering our own faith or lack there of.
If there was no sign in front of the clinic and we’d been taken there under a different pretext, we would have thought we were simply going to meet someone’s family in a small apparently insignificant home on the outskirts of Kigali. The clinic was so inauspicious and unassuming. Some of us had expected to see a large building with modern conveniences, staff in white coats and long lines of patients sitting quietly in waiting rooms, awaiting their name to be called. As it turns out, size really doesn’t matter, it’s the quality of the place and the connection of the people that make something special. The people in this East side community of Kigali are connecting. Members from the local churches are connecting. The families in the area are communicating, educating and connecting by knocking on doors, speaking in the alleyways and markets and embracing their neighbors, one precious soul at a time.