Keeping the Flame: UGHE Student Reflects on Rwanda's Post-Genocide Growth

Orietta Agasaro is a student in the master's in global health delivery program at the University of Global Health Equity (UGHE), a Partners In Health initiative in northern Rwanda. 

When I think about what Rwanda has surmounted in the last 26 years, I’m reminded of a passage from A Tale of Two Cities by Charles Dickens: “I see a beautiful city and a beautiful people rising from this abyss. I see the life for which I lay down my life, peaceful, useful, prosperous and happy.”

I, like many others in my generation, have the immense privilege of enjoying security, peace, and freedom in my daily life. As I reflect on this year's Kwibuka ("to remember" in Kinyarwanda), the 26th annual commemoration of the 1994 Genocide against the Tutsi, I have a heightened awareness of what was sacrificed – toil, suffering and even lives – to put a stop to the genocide.

I was born after the 1994 Genocide against the Tutsi, and am one of the post-genocide generation acutely aware of the suffering endured by more than 1 million victims, and of those who compromised their health and even gave their life to end the violence. I am also indebted to the valiant men and women who have, in the years that followed, given their all for Rwanda’s rebirth and reconstruction. 

Unity, Community in Rwanda's Rebirth

Growing up, I remember being taught about the ethnic divide that led to the genocide, but also about the concept of Ndi Umunyarwanda ("I am Rwandan"). Ndi Umunyarwanda is a national program that aims to promote unity and reconciliation by encouraging conversation about the causes and consequences of the genocide, and about how to rebuild the country by focusing on the national theme, “Remember-Unite-Renew." 

Rwanda was able to advance significantly in its pursuit of unity and reconciliation through several home-grown solutions, implemented at the community level. Those include the gacaca (local community courts); abunzi (community mediators); itorero (youth civic education camps); ingando (solidarity camps); and many more. I had the opportunity to attend an itorero camp in 2015. It not only broadened my knowledge of Rwanda’s history, but also reinforced my Rwandan values, namely Ndi Umunyarwanda. 

The national adherence to, and application of, Ndi Umunyarwanda and home-grown solutions have driven Rwanda’s rapid and impressive development.

Looking at the milestones my country has achieved, I cannot help but feel overwhelmed by a sense of pride and thanksgiving. As a young woman, I take pride in knowing that women have been, and currently are, important actors in Rwanda’s reconstruction and development. It gives me hope and confidence for my future, and for the future of my female friends and classmates.

Gender Equity

In my country, the promotion of women is one of the many milestones birthed through this focus on unity, particularly in decision-making and leadership positions. Rwanda has been recognized globally for its tireless efforts in promoting gender equity across all sectors; we are proud to have the highest percentage of women in parliament anywhere in the world.

Our health sector is exemplary in this regard, and its systems were revived and rebuilt by many strong and resilient women in Rwanda, including UGHE’s Vice Chancellor, Prof. Agnes Binagwaho.

When she gave a lecture to my master's in global health delivery class, I was inspired by her clear dedication to improving health care delivery, upon returning to a devastated country and finding innovative ways to promote health for all, and especially for the most vulnerable, in the post-genocide era. Her lecture reminded me why I wanted to study global health delivery in the first place: to contribute to my country’s efforts to improve the health and well-being of the poor and vulnerable.

I also look up to other pioneers in the rebirth of our health system, including Rwanda's First Lady, Her Excellency Mrs. Jeannette Kagame; Dr. Yvonne Kayiteshonga, the national director of mental health at Rwanda Biomedical Center and the Ministry of Health; and the many, many female health providers and community health workers on the frontlines, who tirelessly work to improve the health of Rwandans daily.

Health Care for All

Rwanda’s strong national governance, paired with leadership at the community level, has been key in finding equitable health solutions that promote health care for all.

From the examples set by these women, I’ve learned that a focus on social justice and a strong moral compass are two cornerstones to success. With scarce resources, Rwanda has managed to transform a broken health system into one that is acclaimed worldwide, through its evidence-based, community-oriented, and equity-driven approach to health.

After the complete devastation the health system experienced in 1994, some would call it a miracle that 15 years later, more than 90 percent of all Rwandans were medically insured, with the poor receiving free health coverage through Rwanda’s Mutuelle de Santé (Community Health Insurance) program.

This achievement has been paired with significant national strides in reducing HIV and malaria rates, decreasing infant and maternal mortality, and increasing access to vaccination. 

Solidarity and COVID-19

The strength and effectiveness of Rwanda’s health care system is now more apparent than ever, as the country is tackling the COVID-19 pandemic.

The multiple measures the country has taken to protect its citizens are testaments to our government’s belief in the value of strong health systems. Additionally, the commitment of Rwandans across the country to follow recommendations from the Ministry of Health and the World Health Organization speaks not only of the importance of good leadership, but also of the values of Rwandans themselves.

Each year, Kwibuka is a time of national solidarity. This year, the Rwandan people stand in solidarity with one another, and with the multiple frontline health workers, police, immigration officers, ministries and health organizations working to combat this destructive virus. 

We can surely hope that if the country continues to deploy its efforts in combating this pandemic, alongside the world, we will undoubtedly win this battle, as we have won many battles before.

I feel a surge of pride for belonging to a nation as bright as mine, and a surge of hope for what the future holds for Rwanda. My hope is greatly inspired not only by Rwanda’s good leadership but also by Rwanda’s highly motivated and socially conscious youth, including my UGHE colleagues.

I admire the audacity that members of my generation have in bringing up difficult conversations, and their ability to find creative and critical ways to arrive at solutions.

Furthermore, these past couple of months at UGHE have shown me what is possible when brilliant minds, driven by humanity, join to contend for health equity. 

I feel a deep sense of responsibility to keep the flame that was lit by courageous Rwandan men and women burning. As a young woman and future global health leader, I strive to contribute to my country’s development by being an advocate for equity and social justice, by treating all with the same compassion shown by those who’ve come before me, and by ensuring that voices long silenced are finally heard.

This reflection originally was published by the University of Global Health Equity.