Horror to hope in Rwanda

March 05, 2007|By Josh Ruxin

KIGALI, Rwanda -- American jets and Ethiopian forces recently conducted strikes in Somalia in support of that nation's fledgling democratic government. The event received passing notice in the United States, but to those of us working in East Africa, and specifically in Rwanda, it was cause for optimism.

It demonstrated the willingness of Ethiopia and Somalia to put aside past differences and unite against radical Islamists who threaten both. It suggested that an era of thinking and acting regionally may have arrived in East Africa. It also marked the return of U.S. military support in East Africa, the lack of which allowed Rwanda to degenerate more than a decade ago into genocide.

In 1993, 18 U.S. Army Rangers were killed in Somalia and their bodies mutilated. It was a small number compared with our body count in Iraq, but the public outcry was part of what caused the Clinton administration to resist getting involved in the swiftly unfolding Rwandan disaster in which nearly 1 million died.

Today, Rwanda gives cause for optimism as well. The nation has been transformed from a nightmare into a model of public improvement. Laws now ban the identification cards, imposed by Belgian colonizers, that helped facilitate the 1994 genocide. And the country is uniting in reform - with government officials, philanthropists, entrepreneurs and investors working in concert to achieve social, economic and health care gains. It is a beacon of hope on a continent where poverty is plentiful and tales of national advancement scarce.

Reform in Rwanda depends heavily on American financial assistance. The Global Fund - a bulwark of public health here - remains underfunded by billions, despite its accomplishments (Congress is currently considering raising its 2007 appropriation by $250 million to $750 million). Offering even greater hope are efforts to reduce poverty by coordinating improvements in agriculture, health, education, gender equity and micro-finance. The Millennium Villages project in Rwanda reflects this approach.

Americans are also investing in Rwanda's businesses and industries, creating jobs and improving lives as a result. U.S. companies have provided tangible benefits to Rwandans by working with them to do business in their country. American entrepreneur Greg Wyler is leading a Rwandan telecommunications company, Terracom, which is turning that nation into one of the most wireless-heavy in Africa. The practical impact on poverty and disease is immense: Treatment, medication needs and disease surveillance can now be addressed quickly and effectively, despite the distances between Rwanda's hospitals and clinics.

Much work remains. I frequently see Rwandans who can't afford the $2 per capita fee required to register for a health insurance card. Some years ago, a 13-year-old at one of our project sites was sick with strep throat, but his parents lacked the 25 cents needed for penicillin. As a result, he developed rheumatic heart disease, which requires surgery costing thousands to correct. But with modest investment, basic universal health care could be available in Rwanda.

Investment in the poor can be quickly felt. Helping farmers produce adequate food for their families must be a cornerstone of development. When combined with efforts in family planning, finance and education, this approach prevents families on the edge from falling into the abyss.

These investments are in our self-interest. Inadequate public health services mean ineffective disease surveillance. The next pandemic could be brewing in Africa without our knowing it, as AIDS did. Abject poverty also is the ideal breeding ground for militant extremists.

I was in a beautiful field in the village of Mayange recently, where I came across a family preparing for planting. The kids - recently seen at a health center we support - were healthy. I praised their father's farming techniques and asked him how long he had been farming. He replied that he had recently been released after nine years in prison for genocidal crimes. Today, he and his neighbors are back in the fields, providing for their families and creating a more optimistic future for their children.

It's a hard fact to swallow that so many were complicit in so much evil. But looking at his children playing with a homemade ball in that field, I felt the bleak past - a mere 12 years later - giving way to opportunity and hope.

Who would have thought that Rwanda could so quickly teach us all to have faith? The question now is: Will it teach us that our own interests are best served by helping others?

Josh Ruxin, assistant clinical professor of public health at Columbia University's Mailman School of Public Health, is director of the Access Project in Rwanda.

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