Inshuti Mu Buzima site background

The tiny nation of Rwanda is the most densely populated country in Africa, with a population of 8.2 million in an area smaller than the state of Maryland. Rwanda is one of the poorest countries in the world, ranking 159 out of 175 countries listed in the U.N. Development Program's Human Development Index; average life expectancy at birth is only 38 years.

Beginning in April 1994, a tragic genocide took the lives of close to a million Tutsis and moderate Hutus in just 100 days. The genocide destroyed Rwanda's already fragile economy, further impoverishing the population, and resulted in a massive loss of health professionals and the collapse of health infrastructure. The skyrocketing AIDS epidemic in Rwanda today is, in large part, a consequence of the violence, instability, and displacement that occurred as a result of the genocide. Estimates vary, but it is believed that between 8 and 13 percent of the population is infected with HIV. Many of those infected during the 1994 genocide—especially women who were the victims of rape—are now suffering from full-blown AIDS.

In the decade since the genocide, Rwanda has made great strides toward peace, stability, and development through positive economic growth and strong national plans for health and education. In 2003, the Ministry of Health and non-governmental organizations working in Rwanda were awarded money for HIV prevention and treatment from the Global Fund to Fight AIDS, Tuberculosis, and Malaria. In the first two years of the grant, 13,000 AIDS patients have received therapy free of charge through the government and its partners. However, much of this AIDS treatment is available only urban areas, particularly in the capital city of Kigali. In seeking to improve HIV care in rural regions, the Rwandan Ministry of Health turned to Partners In Health.

Rwanda and Haiti share many similarities: both are small, overcrowded, ruggedly mountainous countries beset by health and socioeconomic problems. Based on our experiences in rural Haiti , it is clear that there is great need for rapid implementation and scale-up of antiretroviral therapy for AIDS in Rwanda. Recognizing the tragic ties between the genocide and the current AIDS epidemic, the Rwandan Ministry of Health has been one of the most aggressive in Africa in extending HIV treatment to the neediest and most vulnerable populations. Partners In Health thus has an unprecedented opportunity to work in concert with the government and other collaborators to stem the AIDS epidemic in Rwanda.

Rwanda faces an acute shortage of medical personnel, with only one doctor for every 30,000 people. In the rural districts where we are based – Kirehe and the southern part of Kayonza – the shortage is even worse. Until PIH arrived to found Inshuti Mu Buzima (IMB) in March 2005, not a single doctor lived in these areas, which have an estimated population of around half a million people, many of them refugees from war and genocide.

The tasks before us in rural Rwanda are daunting. The people of this region, mostly poor peasants trying to scrape a living out of tiny plots of land, must overcome both the legacy of violence and heavy burdens of preventable and treatable disease. Our first order of business, at the request of the Rwandan Ministry of Health, has been to introduce quality AIDS prevention and care to these two districts. But that goal cannot be met without addressing a host of other medical and social problems.

Malaria is a major cause of death among children and adults in the area. Maternal mortality rates are high. One out of every 25 women die in childbirth, because family planning and obstetric care are unavailable in rural regions. Common illnesses that can be prevented with vaccines, treated with antibiotics and survived by those who are well-nourished continue to kill thousands of Rwandan children. Tuberculosis is currently the leading cause of death among Rwandans with AIDS and kills many others who are not infected with HIV. Hunger and malnutrition are major contributors to most of these deaths and are the principal cause of death for many Rwandan toddlers. Although primary care centers exist throughout these districts, they are understaffed and undersupplied. Rwandan health workers cannot help sick Rwandans without the tools of their trade.