Earlier this week I had been finding it impossible to wrap my mind around the state of our world.  When I closed my eyes and saw skulls and femurs from the genocide memorials.  When I tried to see something else, it was Zainib’s basketball court in Bagdad, converted to a gallows were 20 people a day are being murdered. When I attempted to shut that out, my mind went to Northern Ireland, and when I blotted that out, a thousand other armed conflicts with all their wreckage racked my soul. Torn genitals in Congo, brothels in Mumbai, sewage strewn slums everywhere. Why, why, why, why, why, why?  I understood for the first time why “The Goddess of Nanking,” after personally saving thousands of terrified Chinese from Japanese tortures, promptly killed herself when she got back home to Kansas.

Driving down the spellbinding mountain and uninhibited once more in feeling my feelings, the answer came to me from a very soft place inside: self will.  I have free will, as do all others, and when I am (and they are) in it, look out. I am (and we are) self will run riot.  And that, multiplied by billions of people in and out (some more so than others) of self will, equals the state of the world, good and bad.

And so today I took the focus off all others and their heinous acts, and put it back on myself.  I turned my will and my life over, once more, to a power greater than myself.  So today, just for today, I get a reprieve from the dis-ease that lives in my head, that wants to convince me I am better than (or worse than) someone else. And just for today, I am not a genocidaire. I am not in a militia. I am not a rapist or a human trafficker.  I don’t think  that I, or anyone else, deserves to be punished, tortured, or murdered, for who they are, what they do, how they dress, whom they love, how they wash, how they worship, how they look, where they live.  Because today I have no doubt that with enough self will run riot, I could have become one of these persons, done any of these things. There for the grace of God go I.

Others, I cannot change. Myself, with the help of my Higher Power, I can. I am grateful today I was given the wisdom to know the difference.  It is a deep relief.  In addition to relieving me of the obsession of wanting to understand the totality of everything (I hadn’t even seen I was being grandiose, so complete was the distortion), I can feel such gratitude that today I know what to do without needing to worry about why everything else was done.  All I need to do is the next good, right, honest thing, whatever that might be.

For now, it happens to be to going bed.  It really is as simple as that.

Dushishoze….say that 3 times fast!  Meaning “Think about it” in Kinyarwandan, Dushishoze comprises 4 youth centres nationwide where kids may access free medically accurate reproductive health information, services and products such as voluntary hiv/aids testing (with rapid results) and counseling (and appropriate referrals if they are +…I saw a positive test while I was there) and birth control, as well as activities that improve them socially and economically, with an emphasis on employability. The centers are full service, and I believe this holistic, integrated model is the best and most cost effective way to reach vulnerable youth for total poverty reduction; it is the way forward.

Looking at the old fashioned ledger in which kids who come to the centre sign in, many cited “games” as their reason for coming, but just as many came for counseling, and hiv tests, and for skills learning sessions.  The 4 centers country wide have tested no fewer than 25,000 Rwandais, a huge number in a country with the social disruption it has experienced.

Used to be, aunties and uncles where the folks in a family who educated young people about their sexuality. The complete collapse of family systems, however, in 1994 has left an entire generation, going into a second, in complete ignorance about their bodies.  The average Rwandais woman has 6.3 babies, and they start young. No one has any sex ed at all. It’s absolutely tragic. The centres have replaced traditional cultural practices that were wiped out.

The activities are so cool. There is a weekly call in radio show called “Abajene,” a rally cry for youth, which is hosted by a young idol we have empowered with medically accurate information.  For kids without electricity and phones (so many!) our Cinemobile does tours to rural parts of the country gussied up with an audio/visual kit in order to attract kids, give them “info-tainment,” and let them use the provided cell phone to call in their teen age dilemmas and inquiries.  On site, there is dance, singing, games, recreational pursuits, a football pitch, and job skill training.  Within these “services” kids learn everything from personal hygiene, prevention and treatment seeking behaviors (how/when/why to go to a medical clinic), and let us not forget, they have a chance to simply be kids, to play, to run, to forget, for a few precious moments, all their burdens and cares, the back breaking chores that await them at home, and how they will probably be going to bed hungry.  Again. 

I love this approach, not just because it is holistic, but because it embodies the ideal of collaboration with other grassroots organizations. 

The local Episcopal church is a great friend of ours in this area, and that represents a breakthrough PSI pioneered in Rwanda. After intensive negotiations, all 5 religious entities in Rwanda signed a “non aggression” pact, declaring they would not oppose sex education and pregnancy prevention for youth, and that they would support proven HIV prevention methods. The signees were the Catholic, Episcopalian, Protestant, 7^th Day Adventists, and Muslim superiors and is thought to be unprecedented world wide.  Hearing about how intense the dialogue was, and how it almost fell apart many times, it fantastic to know PSI persevered and was able to help religious leaders grasp that they must not be obstacles to and contradict the use of family planning.  

Children ran about joyfully and my aching arms were at last filled with small ones to tote about with me, to shift from hip to hip, to load on my lap.  In the way of the poor, they could crowd on my lap, up to 5 at a time, and never complain; they are used to being crammed into tight spaces and they each seemed to grateful for touch and nurturing.  Maybe it was all the open windows and the mountain setting, but the children didn’t even smell so bad, except for that one fart!!!

“Baby” was a real favorite of mine. Chubby cheeked and wearing a dirty sea foam green polyester dress, she would stare ambiguously then reward me with an incandescent smile. She was wearing my necklace, which was a flower, and my sunglasses, upside down. I had to pee at one point and reckoned she probably needed to go, too, and she loved letting the sink water run over her little hands. She washed and washed, and I thought, Dushishoze in action!

Her mother is a sex worker who has been reached by Dushishoze.  She and her peers have been educated as to their incredibly high risk for HIV, STI’s, and unintended pregnancy, and how such pregnancies perpetuate the poverty and poor health trap.  They have been given income generating training to ease them out of sex work; as yet, though, they each need the money from one paid sex act a day to eek out a living.  Baby had a pile of brothers and sisters…regulating fertility is an alarmingly urgent public health need in Rwanda.  I can’t say it enough.  

As always, our time was too short and there was the uncomfortable emotional twist upon leaving in not having been able to sit with and honor each person’s story, from orphan to counselor to sex worker to teen ager who is head of house hold.  

Talking about programs like this is always tricky. They do remarkable things….the weekly call in show, nationwide, the 25k kids who’ve been tested, the one on one time that is holding the space a beloved auntie should be filling….but there is always in these desperately poor countries so much more, more, more that our programs can and should be doing.  It all comes down to money.  Rwanda's government  is literally doing everything it can, swimming as fast as it possibly can.  Rich governments like ours, foundations, the private sector, wealthy individuals, we need to be doing more.

When men would not work franticly enough to suit Leopold the Lunatic’s ever expanding need for Africa’s natural resources, he would have families kidnapped and tortured as incentive for the men to run deeper into the forests and bring out her treasures faster.  

The country was raped and pillaged, ancient cultures and social systems were decimated, and the people were utterly lost.  They were ill prepared for self rule, their own historical ways and any self efficacy they had ever had dismantled. In 1960 as self rule began, there were only 17 college graduates in this vast country equal to everything east of the Mississippi.  

At present, in a nation of 2.34 million sq kilometers, there are a mere 2,794 sq km of paved roads.  I am lurching spastically along a typically rutted and pot holed road right now, oy vey!  Papa Jack describes the roads as ravines.  

Destroyed by the Belge then kept down by their first native ruler in the 20^th century, Mobutu Sese Seko, who has the unenviable distinction of a type of rule being named after him, kleptocracy, the Congo, formerly known as Zaire and a lot of other things, has not known peace and stability since before the blood sucking Europeans arrived.  This country, the 3rd largest in Africa and heaving with a massive population growing at catastrophic rate, is chaos.

Thanks, Belguim!  Hope you’re proud!  You built on the Germans nice work on the Herero in South West Africa, out did them, even!

(And for the record, the U.S.A. commited genocide against the Native Americans, plain and simple.  We have our shame, too.)

Right now,  after having taken an hour to pass through a simple looking border that resembles our farm gate, which involved Papa Jack reaching into this pocket for a steady presentation of $20 bills (we joked he should be used to it as the parent of a teen age daughter), we’ve been stopped by “police” in uniform with heave weaponry.  No traffic violations, just a simple and typical moment of attempted extortion.  James our driver spoke Ngali and said we didn’t have any.  I am surprised the police believed him; I have binoculars around my neck and am working on this computer. (Binocs were a fantasy, there is no wildlife here compared to Rwanda; the habitat has been destroyed.)

I am here to visit our partner clinics that specialize in family planning, maternal and child health, and the treatment and prevention of malaria.  (We also do safe water and HIV prevention in this area of the DRC).  I also hope to visit with women who are rape victims. Rape is an epidemic here. It is an emergency. It is everywhere, on a massive scale.  It is not altogether unreported in the western media, but it is grossly under reported.   An ancient and common tool of warfare, this area’s female population has been hostage to gender based violence for decades.

What a shocking difference a few feet makes. On the Rwanda side of the crossing, the roads are tidy, neat, maintained.  The earth is red and the wind through the trees, the lapping of the shores of Lake Kivu are serene.  There is a sense of orderliness and even within the clear poverty, I feel the purposeful attempt at self improvement, through agriculture and the tiny, colorful flower gardens. 

Passing into the DRC, however….Oh my God. After a few villas a relentless, vast dusty slum opens up.  There is rubble, garbage, filth, people covered in muck and grime, buildings that are nothing more than  lean-to shanties.  The earth is grey, drab, choking with dust, visibility limited by dust.  

In our clinic, the back wall is thin and see through, made of mismatched boards roughly nailed together. The padlock surely indicates someone’s sense of humor. The director of the clinic does a good job of keeping the space tidy, but it’s hard. Even here where women gather for family planning and materal/child care, to give birth and for gynecological care, there are patches of rubbish.

I sat with the director and we talked shop. He has a routine of in-home visits to generate interest in family planning (birth control, birth spacing, pre and post natal care).  He has office hours Modayn-Saturday, which are painted in a sweet shade of blue paint on a rough white stucco wall.  

He reports that 20-25 new women present each month to access services.  Though this number sounds small, he says it represents significant cultural change; men want their women to produce as many babies as possible.  Women are for breeding. For them to begin seeking to regulate their fertility is big news.  

In terms of options, injectable birth control is most in demand. There is a misconception that IUD’s make one sick, so he is dealing with that, one woman at a time. The pill, he said, is terrible, as compliance is very erratic and the water they take it with is usually unsafe (infested with parasites, fecal matter, etc….that is what we mean we talk about “unsafe water”). 

The babies he delivers are often premature and the infant mortality is the highest in the world. He treats women who are victims of sexual violence daily. Children are common, little girls 4, 6 years old.  Normal, every day occurrences, including gang rape.  They suffer traumatic fistula rupture and more.  They become HIV+.  They become outcasts.

When I asked about where this pervasive practice of rape comes from, and was it cultural, he said it was not cultural to begin with. He repeatedly said it is a weapon of war and armed conflict, and that there has been violence and instability for so very long, it has become the cultural norm, the way poverty, lack of services, hardship is the norm.  Now, it is all generations know.

I asked him whether he believes the Congo is fit to receive international aid; can donors trust the money gets to his clinic and others like this, will the products and services reach the people?  He said if money can come to “la base,” (the base), then it will benefit the base. We discussed at length accountability and transparency, and some good movement on the government’s part in creating a Parliament and other bodies that will get the money to neediest quickest.  They need the money as sorely as any where I ever visited. I am straining to convey the urgency of the need here, the level of horror of daily life.

The stench of Goma is putrid.  There is no sanitation. The water is unsafe. The rooms of the next two clinics I visited were stuffed with people who were malarial; although children under 5 (undeveloped immune systems) and pregnant women (taxed immunity) are most at risk, here in Goma there were patients of all ages.  They looked miserable, their bodies sagging, their eyelids heavy.

I sat on a few beds, making small talk about future prevention and in my own way hopefully introducing the possibility of each individual making a commitment to sleep under a “mousquitaire”  when they go home. We also talked about the treatment, the artemenisin based meds that are working well (there is 60% resistance to the most commonly used treatment).  

It was a visiting day, so most patients had family in, grandmothers, other children, and siblings.  One had a transistor radio.  One man was feeding his small son, an iv pick awkwardly taped to his hand, which it dwarfed. The boy was lethargic and mute, his nose ran. The man fed him black beans from a tin plate, around which gnats flew.  The man was a very hard person, as were the other men with whom I spoke. He raged at pregnant women to whom we give nets for no charge when they come to the clinic: Am I not a man? Should I not be given a net?

I asked him if nets were available in the private sector and he said yes, but that he has no money.  I said, “Oh, come on, I bet you have a little money from time to time for a smoke!” “No!” he exclaimed.  “Beer, what about a glass of beer?” Again, “No!” he declared.  “Ah, you have so much virtue!  Such a clean life!  But….I bet from time to time you have a little money to spend on a woman!” The room erupted into roar of laughter. (It is very well documented, through micro financing organizations, that men in the developing world waste money at shocking rates, where as women save and invest every pittance.)

We debated the value of investing in prevention by spending .50 on a net. “Wouldn’t it be wise,” I said, trying again, “to spend a little money for a net, so as to save all it costs when you’re sick? When the children are sick?”  I gestured to the tiny, stifling room, loaded with prone bodies. He had no response to that. 

I don’t think he has anything against buying products.  For example, he had a high end mobile phone with incredible features and decent clothes. His grudge against buying a net is that some women get them for free.

A lovely little girl was eyeing me cautiously.  She began to stare at me more openly, and I thought to take her picture and show her the image.  Perhaps it would please her.  Instead, the man leapt up in between my camera and the room, blocking me from not just his boy but everyone in the room.  I explained what I had meant to do, and that it was a means of reaching out to a new friend, and he began to mock me.  He got his phone out, scrolled through its zillion features, found the camera, and ran all over room as if taking my picture with it.  I hammed it up, posing from each angle to which he darted. Everyone giggled, the tension slightly contravened.  Voguing in the DRC. 

It was time to go. I thanked everyone for the visit, wished them a good afternoon, a speedy recovery, and good health.  I walked to the car wondering not if, but how many, has that man has raped.

The Minister of Health and I would be criss crossing Rwanda to celebrate World Malaria Day with PSI. During the flight, I took some quiet time to myself, did my daily spiritual readings, and listened to my favorite far out spiritual music on my iPod. 

I admired the verdant hills below, and began to register what I heard, that every square inch of the land is tilled in the effort to feed all 10 million people living here.  The land is intensively cultivated, gardened, terraced. It must be, or they go hungrier than they already are. 

We landed in a giant field in the Est Province, greeted by hundreds of onlookers who were curious about the helicopter.  Cries of “mazunga” erupted as my colleagues and I got into our cars.  We jolted across rough, red dirt roads to visit to see a community health worker in action.  In a small, poor home, we visited a broken woman holding a limp infant. The community health worker had diagnosed malaria, and was giving her education about her new impregnated net and proper use of Primo treatment. I sat with the woman, but she was not easy to engage, she herself was so ill and  seemed very overwhelmed.  I tried to squeeze in a few quiet moments with her, as I am not a "breeze in, breeze out" kind of gal.  I like to learn the stories of the people I meet, to share in their lives as much as I can, form an emotional connection. My only real contact with her, however, was that she smelled so rotten I actually had a gag reflex, a first for me in 11 countries of slums, brothels, and hospices.  It was very sad.  I didn’t even get her name.

In a back of the miniscule house, a woman who rented the bedroom had her net hanging proudly over her bed. She was wearing a matched lavender outfit and we sat under her net giggling, unable to understand one another with words, but giddily connected somehow.  She was really precious and very proud of herself, so proud everyone came to see how she uses her net. I saw her again later at the clinic and we gave each other a sparkly look.  Jungian, those meetings.

The community health worker, as all are, was special. To gain the post, he had to explain to his fellow villagers, perhaps with some competition from others, why they should choose him for the job. I picture him standing on the grass, surrounded by cassava, corn, and beans, maybe some hedges in bloom, with rough finished shanty shacks around him, a few goats or cows near by,  his community quietly assessing his ability.  Once elected, he receives 5 days health services training (eventually I met the guy in charge of the hospital in Kigala where the folks who train the CHW’s  are trained. The decentralization here is fascinating).  In his kit he has life saving pharmaceuticals (antibiotics, i.e.), family planning methods, malaria treatment (PSI products), and some non pharmaceuticals.  He is available in his home and goes to those who are too unwell to traverse the mountains.  It is worth noting here that this job is unpaid, and when the CHW’s are asked by the government what they need, wellies [rain boots] are often mentioned, so they can keep walking to sick people in the rainy season.  When I asked this CHW if people stop by at all hours of the night and day (my personal worst nightmare), he said no, that they all see each other fetching water at the river, searching for firewood, and in the fields.  They chat informally during daily life to make their appointments. 

And so we partly celebrated World Malaria Day in this home, showcasing how nets, treatment seeking behaviors, and Primo can reach every household in Rwanda, even the most remote and poor.  It showed how to complement private sector and clinic availability of goods and messages with a creative, partnered government initiative.  It was a good visit.

I slept with my pretty new sapphire earrings still in my ears, head perfectly straight on the pillow, ankles crossed.  I did not flinch, apparently.

I roused about 7:15, after Staci was scheduled to arrive for my briefing. I boiled the kettle and made some green tea and she arrived just in time for me to serve us both some.  Soon after, the great Zainib Salvi arrived, resplendent with her chic cropped hair, black silk shirt waist dress and fabulous beaded necklace. Man, Mr Armani would love her!  Some women do so much with so little!

Zainib sat next to Staci and I quietly snuggled into the sofa. I was feeling very vulnerable after my sleep, undefended and wide open. I enjoyed my delicate state as these two remarkable women put on an unselfconscious show of empowerment, talking with intimate knowledge of global poverty and armed conflict, how girls and women and the environment are the wreckage, and the simple grassroots solutions that are the way out. Dang, I thought, you women are fine, and I want to be you when I grow up!  

Zainib does use the word “fascinating” a lot, but always accurately.  She will punctuate the beginning of yet another story with the point of a finger, leaning forward, her voice taking on even more enthralling energy, and the next thing I know, I have been schooled, for example, in the border conflict between Rwanda and the DRC, exactly who the militias are,  or some such other elusive subject.

When Kagame offered in 1996 to help a hapless rebel named Kabili “go to Kinshasa,” to oust Mobutu the Mad, the trade off was the Kibali would send the Interahamwme, the Hutu  youth genocidaire who fled to the DRC when the genocide was ending, back home.  He did not, and they are still there (they are by and large the rapists terrorizing the DRC, and this behavior has had a “contagion” effect and now rape is daily life) and they still long to fulfill their genocidic ideology.  Plus, there are the Tutsi who fled the genocide as refugees who are still in the DRC, plus Congolese rebel who are simply doing what rebels do, raising hell and disrupting everything. All are armed, and Zainib explained that as wars always do, it has become about the economy and land and exploiting natural resources.  Or, as Dario puts it, they start fighting over the color of p***lt;/p>

This background was important for me as someone doing public heath and human rights in Rwanda, and because however repugnant, I long to learn more about gender based violence in the DRC. To that end, I am planning a day trip to Goma, just across the border from where I will be later in the week.  The area in between Kinshasa and Goma is still  very unstable and  often dangerous, so I can’t get there from Kinshasa (and who wants thousands of kilometers of unpaved roads, anyhow), so I am going to slip in from the Rwandan side.

I do not mean for the synopsis above to be thorough and inclusive of all sides of the story, but rather to demonstrate the dazzling commitment and depth of knowledge these women have.  I am in awe that this is their lives 24/7/365 and the world is a better place because they are in it.

Having finished her book in Brussels, I asked Zainib about her brothers. One is safe in Chicago, but the one in Jordan and must renew his visa yearly. She is sure he’ll be assassinated if he ever has to go back to Iraq; about 20 of her friends, educated, empowered women, have disappeared. They are doing the Pol Pot thing, wiping out the educated classes; Zainib’s family home has recently been taken over by a militia and her neighbors are sad to report that her brother’s and her basketball court has become a gallows. The number 20 came up again: number of assassinations daily.

Years ago there was an Oprah magazine in a seat back pocket on a flight and I flipped through it. Or maybe I bought it, the issue with Bono on the cover. Anyhow, there was a tear out card describing Women for Women International. I was so intrigued and I challenged my Feathered Piper yoga sisters each to sponsor a woman in a war torn country.  This is Zainib’s program, founded in Serbia’s rape camps during the war in Bosnia, and based on her own experiences growing up under a dictator (Saddam Hussien).  Since then, I have given sponsorships to other special women in my life.  Quite wonderfully, a group of my sisters were graduating from a Rwanda program during my stay!  I missed meeting them due to my canceled flight, but it was fantastic to meet Zainib and plan my visit to Goma to see a program there, were gender based violence is a daily occurrence.

Letters from my different sisters are always a delight, and I appreciate how W4W includes a snap shot. Mary Ogeke in Nigeria, gathering kindling for boiling water is my favorite.  Expression-wise, my sister who recently asked me which I preferred, “the rainy or the dry season,” (ah, we see the world as we are), and wished me “more grease for your elbow,” is my favorite.  See, what separates us? Nothing really, only our misperceptions.

Eventually the phone rang and Zainib’s colleague said the First Lady was waiting for us (oops)!  I threw my dress on and downstairs we went.  I was disappointed to see a big room with dining tables and place cards, drats, I wanted to pop in and out and get back in that magical bed!  But, it turned out to be a very healing night. The great Aloysie Inyumba, currently a senator and formerly the Minister of Reconciliation and Healing, hugged me so warmly.  Growing up, she was a refuge in Uganda, and said her mother, although uneducated, was bright, and made sure her 3 daughters made it all the way to university. She received her degree in Social Work and I forget what else.  When she came back to Rwanda at the president’s quest, she made minister and she got to work, fast.  In 2002 there were 120,000 genocidaires still hunkered down in a fragile prison system awaiting trail, and the then-Minister brought back the Gacacas, meaning “patch of grass,” courts.  250,000 people were elected within their communities. They received brief training in law, judicial ethics, and conflict resolution.  11,000 grass courts were established, each with a panel of 15 judges and requiring 100 villagers be present to make the trial valid.

This is just one of her many, many accomplishments….She is a special lady.

She took me over to the First Lady at the right moment. Madame Kagame is a physically imposing presence, and somewhat stoic, perhaps even dour.  But I couldn’t really process all that because I was having an attack of static cling, and my dress was all up in my *****.  I know this because the First Lady’s aide de camp was on her knees behind me, pulling my dress off my backside.  Hmmm.  Was it to protect my modesty, or the decorum of the entire event? I was, after all, smack dab at the front of the room, back turned to the crowd, a movie star chatting with the First Lady. What a lousy time to get a bad case of hungry bum!

Better events followed. The most extraordinary drumming and dancing began, and I could feel the pain of earlier in the day be vibrated out of my chest.  I was absolutely in awe.  This is the Africa I believe in, its traditional culture and arts in tact and shining amidst educated,  empowered people talking smart about gender equality and development with an eye on 7 generations ahead. Even though we were in a hotel’s spiffy ballroom, when I closed my eyes I was in the bush, around a fire, the sounds of the wild engulfing me.  It was fabulous beyond description. The senator narrated each dance for me:  Ah, this is the dance about millet, teaching and celebrating agricultural practices, valuing production to keep everyone fed. Ah, this is the dance for the herd, the grass at the end of their sticks is to clean the herd, ahhhh, this is the dance of women, celebrating their beautiful bodies! My gosh, I live for this stuff!  It’s what I dreamt of in college!

Zainib was equally moved, and I noticed we each kept placing our hands on core parts of our body.  We all had tears coming, too. Zainib and I had already leaned into one another, speaking confidentially about the intense personal work it takes to stay in this game, human rights, social justice, poverty reduction. We traded notes about our core pain, why we were drawn to such problems in the first place, and how we have found our own personal solutions along the way.  I used to live with nothing but problems, I could tell you everything about them in exacting detail.  I am grateful today that I have solutions, a way of life which I know works on any problem I may have. I take certain steps, and the result in a psychic change and spiritual awakening. That I am here in this room right now is proof.   How did I get here? By the grace of  loving Higher Power that does for me what I cannot do for myself.

Although I was very caught up in the moment, a tiny thought crept into my head: How do I get more of this?? Then, an idea was born, bring them to the U.S.!  I excitedly began to ask the Senator if they were a formal dance troupe (yes), and didn’t she think it would be extraordinary for them to perform in the U.S., to help rehabilitate Rwanda’s image abroad, to raise awareness about yes, the need for development funding, but also, the many, many good things that are happening here? Oh my gosh, we were beside ourselves, and came up with so many ideas. She and the First Lady will come, I can book them at TPAC in Nasvhille and well, shouldn’t I really involve a professional promoter?  In fact, as many people as possible should see them – New York!  D.C., an event with PSI that I could host with special donors!  And the best idea yet, I am friends with a band, a really special band, and they are touring college campuses in the fall, and haven’t I just found the perfect opening act for them!!!!!!!!!!  We were elated!

On this wonderful optimistic note, after splashing handfuls of water on my silk dress in a futile attempt to arrest static cling, the Senator held my hand and walked me to the lift.  It was time for bed, and I valued her hugs and gentleness as a child does a bedtime story.  Rwandans are kind, but there are not very touchy feely, except her, lucky me!  Only one table leaned toward me as I passed and in a desperate stage whisper said, “Your dress is hiked up all the way  and you underpants are showing.”  I was unperturbed, knowing it was no big deal, really, for after I all I actually had some on for once in my life. 

I closed my eyes, and when the skulls came I let the drums beat them out of my head.  I slept pretty well, and woke up curious about another day in this lush land.

From the description of the population problem, next I was immersed in the world of Five and Alive, what we call our programs that help children live their 5^th birthday, no easy task in poor countries.  This year, 10 million children world will die before their 5^th birthday from pneumonia, malaria, diarrheal disease, and other easily preventable causes.  Rwanda’s government, in addition to wanting very much to meet the Millennium Development Goals, has set “2020” goals for itself, and to that end has one of the most intensive child survival and maternal health agendas in the world.

And, they need it. 1 in 12 children born here will die before age 1, and then an additional child per 7 will die before 5.  Malaria, preventable and treatable, is cause number 1.  There are 2 million cases of simple malaria a year in public health facilities and 4 million cases that are not treated at all….children average 2 – 3 cases a year.  Death by mosquito bite.  I think that the next time I play badminton and get all annoyed I’ll remember, at least it’s not killing me and my babies.  

To take this on, we socially market a net called “tazanet,” which is pre treated with the appropriate insecticide and lasts for 3 years.  It is available at very small price which research shows different sectors of society can afford (“market segmenting”), and we give them away for free in many areas as well. This blended approach of private sector availability combined with recent free distribution of 3 million bed nets to caregivers of children under age 5, pregnant mothers, and the HIV+  helped achieve a stunning 60% reduction in malaria cases in 2007!  This is the greatest reduction of malaria rates in the world, something the government can be very proud of doing for its people.

For treatment, we have made Coartem available at government 227 registered pharmacies nation wide (registered is important to ensure correct education is given with the sale of the product regarding its use to avoid generation of myths and creation of resistance to meds). We have “over packaged” from the manufacturer, one of my favorite things that we do. We make it a brand, “Primo,” which we can “market,” and provide pictoral and local dialect instructions for the low/non literature. Even the photos of the babies guide care givers to correct dosing based on age.  It’s a truly wonderful thing and I get very, very excited about over packing!!!!!!!!!!  (Another piece of malaria treatment is presumptive intermittent care for pregnant women, who are very susceptible to malaria morbidity/mortality.)

Publicity and marketing campaigns, via billboards, paintings on buildings, radio and tv spots and “info tainment” like skits and plays, puppet shows, etc.  help create awareness of  the need for sleeping with a mousquitaire,  tazanet as a locally available LLITN, symptom recognition/treatment seeking behaviors, as well as drug compliance.  The umbrella term for all this is “Behavior Change Communications,” BCC.  Perhaps this is a good time to mention that Staci, our Country Representative, did her undergrad at UCLA and her MBA at Columbia!  Our social marketing staff generally have both multiple degrees and Peace Corps backgrounds….very, very cool folks.

I went to our offices, set in a very nice two story building with lots of doors that open onto a small hillside; there was a rondelle of Cosmos growing by the PSI sign and the welcome desk included a dry eraser board where our staff sign in and out.  There were some small trucks with our  medical goods’ brand names (primo, confiance, tazanet) painted on the side. Below the building is a garage that has been converted into a warehouse for our products, and is from here we begin to distribute them out to the poor people who need them. I saw boxes of long lasting insecticide treated bed nets, coartem, our artesmin based anti malaria drug, various methods of birth control, and sur eau, our point of use water purification product. Our staff in the warehouse consist of women we have sensitized via peer education about the risks of commercial sex work; most have been able to retire, as a result, from sex work altogether, and have created a co-op in which they pool their money to buy supplies to make crafts.   It is really fascinating to see poverty reduction solutions in action, and how one good action opens the way for yet another to manifest.  

I loved meeting everyone and am so proud we are able to employ so many smart, committed, compassionate locals. In this way, PSI helps contribute to the local economy, increases employability by adding to job experience, and of course more effectively creates and runs programs that appeal to Rwandans themselves, as they are created by Rwandans. This is our policy world wide. One must understand each tiny micro culture and habit and dialect in order to create positive behavior change within it.

I sat down after a round of introductions (I always mention we have 5 cats and 2 dogs because it gets a shocked laugh, hungry  societies don’t keep pets, and so the concept  does not exist at all), and was prepared to be dazzled by the presentation our staff would make, et comme d’habitude, I was.

Rwanda is a country of 10 million people and it is growing at a terrifying rate, one of the fastest growth rates in all of Africa.  They have already run out of space.  As mentioned, every inch of earth is cultivated yet there is wide spread food insecurity.  There are the predictable environmental consequences: massive deforestation, erosion (Egypt is getting all Rwanda’s topsoil; the Nile has its spring source in Rwanda….fascinating), loss of biodiversity.  I was warned that I would never be alone (something everyone knows I need daily) as even in the most remote parts of the country, people would be…everywhere. And it’s true, they are, even unpaved rural roads are lined with folks walking somewhere, perhaps in a blue school uniform or with baskets of goods or a jerry can of water on their heads.  Off on distant hillsides I can see people gardening.  I will try to go pee behind some tree or bush and sure enough there is someone farming a few feet away!

At its current growth rate, which is 6.3 children per woman and outpaces economic growth by almost an entire point, Rwanda’s population will triple 2030, which surely means catastrophe. Famine is inevitable, the  pressure on space to a crisis point, economic and public  health collapse, infrastructure that cannot meet needs, and ultimately, political instability. It is this, political instability, above all things, Rwanda seeks to avoid, and therefore, family planning is at the very top of the government’s public health plan.  However, even if the government, with PSI’s help, meets its most fantastic fertility regulation goals, by 2030 the population still will have doubled.

I find it wonderful that this government is smart enough to regard poverty as a key political issue.  Sure, they want to reduce poverty for all the more socially recognized reasons, but having come out of genocide, and being intensely motivated to avoid bloodshed in the future, they get that poverty breeds instability.  This is always something I try to bring to my talks in the U.S. when people say, “Why should we care about poor people abroad?”  The One Campaign to End Poverty does a great job of articulating this.

So, we help the government with family planning.  A variety of options are available to individuals and couples:  oral, injectables, male and female condoms.  We brand and socially market them and in cases of extreme poverty give them away (even though the cost for any product is extremely low, but some cannot afford to spend even those pennies) and we helped prevent unintended pregnancies since 1995.  Even though only 1 in 10 women is using modern birth control, that number is still twice what it was in 2005!!!! We also do STI (sexually transmitted infection) and HIV prevention education.  Some products we receive at subsidized prices, but believe you me, there are plenty of manufactures out there who will only sell to us at market rates. People who make money off poor people make me sick.