First Week as a PCV

Written on July 25, 2012

All week I’ve been in search of a teacher to teach me Kinyarwanda two times a week. I’ve asked everyone. And it is particularly difficult right now because Rwanda just went on summer vacation, so there are no teachers around. Also a large amount of the teachers in my community are Ugandan. They speak about as much Kinyarwanda as I do. Awesome. So I’ve been asking everyone that works or lives around me. Clearly I need to practice my Kinyarwanda more, because when I ask “Uzi umwarimu azagisha ikinyarwanda, kuko ndashaka kwiga? Ariko arashaka kuvuga icyongereza, rero ndashobora wiga” (Translation: Do you know a teacher that will teach me Kinyarwanda? But she/he needs to speak English, so I can understand). The response in return: they smile and raise their eyebrows twice. What does that mean?!? Is that a yes or a no. And I will go further and say “yego cyangwa oya” (yes or no). And the eyebrow raise happens again. What is that!? I have never been more frustrated in my life.

The other response I get is: “You speak good French, everyone here speaks French, why do you need Kinyarwanda, speak French.” Because Peace Corps is making me! I also will travel to other parts of the country where French is not popular. I will need my Kinyarwanda then.

Okay I think it is time to explain the Rwandan Health Care System, you know, since I am working in a Health Center and all.

It is organized in the shape of a pyramid. I would use visuals, but my illustrator program isn’t working, and I can’t use Word because the design is terrible and unattractive. So imagine a pyramid. At the very top:

Rwanda Ministry of Health

(then)

Regional Health

(then)

Provential Health

(then)

Distric Health

(then)

Health Centers

(then)

Community

Rwanda is organized in a system or provinces, districts, sectors, cells, and umudugudus (villages). For example: I live in the Eastern Province, in Nygatare District, Sector Akagera, I don’t know my cell, and my Umudugudu is Cyabayaga.

During training we had a representative from the Ministry of Health, explain everything to us. This is what we were told. There are five providences in Rwanda. Four regional hospitals, that work at a national level. Forty one district hospitals, out of thrity districts. And four hundred and sixteen health centers in Rwanda.

Most people in Rwanda do not have any sort of transportation, besides their legs. Therefore Health Centers were set up around the country to provide health care to Rwandans at an umudugudu level. My Health Center is in the middle of three villages, Cyabayaga, Bushoba, and Gatchtrilliage. The next closest Health Center is an hour away by motto, and walking there really isn’t a possiblity. The district hospital is thrity minutes away by motto. This is very very rare. Most things are not that close or convient.

If you are sick, have a tooth ache, a broken body part, or anything else wrong you go to a health center. After seventy two hours if your condition is not better, you are sent to a district hospital. If the district hospital cannot treat you, you are then sent to a Province hospital. So you slowly move up the pyramid, and hopefully get better.

Health Centers are free for everyone, but if you skip the first step and go straight to the district hospital, they bill you. And as far as I understand, health care is free as long as you follow the pyramid system.

Not every health center has a doctor, they’re not required to have doctors. Nurses are required to run the health centers. But, mine does, because it is an awesome health center.

These are the ratios for hospital staff, to Rwanda population:

1 Medical Doctor to 16,000 people

1 General Practioner to 10,000 people

1 Nurse to 200 people

There are eight to twelve general practioners in every District Hospital.

Nurses:

There are two types of nurses. A1 and A2. A1 has the equivilent of an associates degree in America, A2 has the equivilent of a high school diploma in America. Once they have been an A2 nurse for five years, the Ministry of Health pays for any higher education they wish to achieve.

In 2007, seventy seven percent of Rwandan’s live an hour walking distance away from the health center. The representative did not have the updated statistic. The goal is for one hundred precent of Rwanda to live in walking distance from an H.C.

A Health Center treats on average 25,000 people in one year.

This past week I made a map of my Health Center. The map was more for myself, but I thought I’d share it to (hopefully) give a better understanding.

The second picture connects to the first on the the left side where it says path to my house. If you have a Mac I strongly recommend holding the command button and the plus sign button together and zooming in.  

The services provided at my H.C. include:

General Hospitalization

Medicine Distrubition

On call Doctor

Vaccinations

Pharmacy

Maternity Ward

Laboratory

Family Planning

P.T.M.T.C.T. or Parent to Mother to Child Transmition

Nutrion Classes 

Social Worker

I think I covered everything I can think of for now. If you have any questions, comments, or concerns please feel free to contact.