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Public health [Journey to Rwanda]

Rwanda-children
Sue Horton, Op-Ed and Sunday Opinion editor of The Times, is in Rwanda on a two-week Gatekeeper Editor fact-finding trip organized by the International Reporting Project. She is chronicling her trip on the Opinion L.A. blog.

Tuesday, Nov. 15:  The statistics are impressive. Healthcare in Rwanda -- and access to it -- has improved dramatically in a very short time.

Between 2005 and 2010, mortality for young children has been more than halved, and both the malaria rate and maternal mortality have dropped significantly. Ninety percent of children are fully vaccinated. The country has quite a low rate of HIV infection compared with other African countries, and those with the virus generally have access to treatment.

As of 2010, 90% of the country had purchased government health insurance, though there is some indication that the number of insured may have dropped drastically in the wake of cost hikes (to a maximum of $12 per year per person, with a sliding scale that allows the poorest to be fully subsidized).

The country has instituted a system in which local health workers visit all the families in their villages regularly to perform routine healthcare. They can then refer patients to community health centers or to hospitals if appropriate.

We saw the highly local healthcare in action in a village in eastern Rwanda, in a dry part of the country where hunger has traditionally been a big problem. Now the government and the Catholic Church have collaborated to combat malnutrition at the Rilima Nutritional Center. If a child is identified as undernourished or is failing to grow properly, the mother can go to the center, where she gets extra nourishment for the child, along with lessons about what to grow in her garden for maximum nutrition and how to cook healthful food.

Still, the need is overwhelming. A 2010 health survey found that 37% of kids have stunted growth from malnutrition. About 76 in 1,000 kids die before they are 5. And even the best healthcare facilities lack things that U.S. hospitals consider necessities.

We visited a state-of-the-art hospital a couple of hours outside the capital, built by the international health organization Partners in Health, Rwanda's health ministry and the Clinton Health Access Initiative. The 150-bed facility sits on top of a high hill above the small town of Butaro. Before the hospital was built, the country's northern district of Burera, with a population of more than 320,000 people, had just one doctor. The new hospital is beautiful, with a commanding view of the surrounding countryside, and American doctors work side by side with Rwandan doctors to provide excellent care. But every day they have to make compromises.

Recently a child came in with severe kidney disease. They sent him to the capital for a scan, which showed the extent of the disease, but treatment really isn't possible. There's simply no access to dialysis, much less a kidney transplant.

Every day people start lining up outside the hospital at 6 a.m., and the parade of patients doesn't stop.

PREVIOUSLY:

Sunday, Nov. 6: Journey to Rwanda

Sunday, Nov. 6/Monday, Nov. 7: Two views of President Kagame

Monday night, Nov. 7: First impressions

Tuesday, Nov. 8: Law of the land in Kigali

Tuesday, Nov. 8: Capital growth, for good and ill

Wednesday, Nov. 9: The master plan in action

Wednesday, Nov. 9: Genocide Memorial: Encountering the dead

Wednesday, Nov. 9: Rwanda's take on the Conrad Murray trial

Thursday, Nov. 10: Genocide survivors' testimony

Friday, Nov. 11: Rwanda's strengths and challenges

--Sue Horton

Photo: Pastor Rick Warren of Saddleback Church in Lake Forest, Calif., greets children before visiting a hospital in Kibuye, Rwanda. Saddleback Church hosted the 2006 Global Summit on AIDS and the Church. Credit: Allison Cox / Saddleback Church

 

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