We were thrilled to welcome Lisa McBeth and Kelsey Bristow to Banda village this summer and we wanted to share this beautifully written recollection of the visit from Lisa.
Lisa is Maternal-Child faculty at the University of Delaware and has always been interested in maternal mortality and global health for childbearing women. She has taken nursing students to South Africa and Peru to volunteer in clinics and labor wards and this time to Rwanda, she brought Kelsey with her. Kelsey is an accelerated nursing student in the program at the University and has a deep interest in global health and development for women as well.
KOMERA
We arrived In Rwanda August 2 after many hours of travel and it wasn’t until the 4th that we took the long drive to Banda from Kigali. You can read about this beautiful country but it is nothing compared to seeing it first hand. It truly is the land of 1000 hills and little did I know how much we would be walking them in the week to come.
Arriving in Banda was our first glimpse of the amazing women and children we would come to know so dearly over the course of a week and a half. And as we settled into the guesthouse, the sweeping view of our part of the village was stunning. One of my most wonderful memories is waking to the sounds of village life every morning. No cars, traffic, city noise, electricity, just the sounds of first the birds, then the cows and roosters, to the children and people starting to move about the village for the day. A simple joy that I still miss. We had our first glimpse of the Kageno workers we would come to know as friends and the amazing food that we could look forward to every day from Christine.
Over the course of our stay we had been asked to do a needs assessment on the pregnant women in the village, and Lyla had made every arrangement possible for us to allow us to do just that. We started with meeting the nursing staff and getting a tour of Kageno and the grounds. The nursing staff consists of 2 nurses provided by the government and 1 Kageno nurse. This is Jeremiah. Jeremiah is amazing and was so welcoming and also became our interpreter over the course of our stay. He was so interested in the ideas we brought and helping us find ways to educate and better help the women in the village. One of the ideas we brought was to possibly introduce Kangaroo care to the women, which was embraced by the staff. This is something we are working on to be able to present in a way that will enable the women to embrace this concept. Updates to follow.
Kelsey and I had heard how the women had to walk 3 hours to the nearest clinic when they were 28 weeks along in their pregnancy. They then stayed there until they gave birth, in case of any problems, and then walk back the 3 hours the day after giving birth. Often alone and carrying baby and what little belongings they had taken with them. Kelsey and I were determined to make that same walk. We had to know what it was like. So Lyla had arranged for us to go to both the district hospital, Kibagora, and the regional center, Rangiro. Kangiro is where the highrisk women are sent to deliver their baby. We were able to meet with the head of the hospital.
Although impressed with what was there, it is very hard to get accurate numbers about maternal mortality and infant mortaliy. At Rangiro we met with the head as well, who is a nurse, since the regional centers have no doctors there. This too was a nice center, but for Americans giving birth in either of these centers would be unimaginable. The people and staff are all very welcoming and at least the Rwandan government is trying to prevent women from dying in childbirth. While not a perfect system, it certainly has decreased the rate considerably. The highlight came at the end of the day when we set out on foot for Banda. Now we knew it would be about 3 hours, but it definitely took longer and as we made it back into Banda, we no longer had light. We figured we’d walked at least 9 miles home. Remember those 1000 hills I talked about, well we walked 999 of them. Or so it seemed. The guesthouse and Christines’s food was never better.
While at Banda, we went on homevisits where we were able to see the women and infants and children and see how they are growing and find out a lot about the wonderful feeding program provided for the malnourished children. Each family with children in the program has been given seeds and taught how to grow new nutritious foods so they can feed their family and give back to the program. Many were doing quite well with their gardens but some still had trouble growing and sustaining their gardens.
As we went from home to home Kelsey and I started to notice we had a following. By the end of our visits there was at least 30 children following us. This became a normal occurrence for us and one I also miss, being greeted and followed by the wonderful children every day. One thing that was really hard for me to adjust to was assessing age. By size these children all looked at least 2 years younger than they actually were and we saw Kwashiorkor wherever we went. Seeing the malnutrition up close and personal was one of the saddest things we witnessed there. Most Americans only see it from pictures and so it is detached from them, but this problem exists in the world and hopefully one day malnutrition will be a thing of the past.
I think the highlight though was talking with the women directly and asking them what their biggest problems were and what was it like to have a baby in Rwanda. Everything they told us was pretty much what I had thought from my time spent there. Some of the key issues were the distance the closest center was that created the necessity to walk so far and leave their families for such a long time and the need to provide money for their family which means many of the women are back in the fields working as early as 2 days after they deliver. Still bleeding and carrying their infants on their back, while hoeing, planting, and harvesting.
Hearing their struggles and what they go through brought tears to my eyes on several occasions. But these women never complain and are so joyous. I just loved being among them. We were taught the word for strong or to be strong in Kinyarwanda and it is ‘komera’ and meeting these women I understood the definition. I thought I was komara but these women are truly ‘komera’.
Obviously there are many things that could help make a difference for these women throughout their pregnancy and into the postpartum. Currently my highrisk labor and delivery class is working on developing sustainable, culturally sensitive, and inexpensive projects that may or may not work in Banda. But I wanted to challenge them to think outside the box. I don’t know if any can be adapted there, but my heart is still in Banda, something about that beautiful remote village, is not letting me go. So at the very least I hope to go back next summer with some educational materials that will help them decide if they want to give Kangaroo care a try. And of course I’ll be taking any other projects designed by the students that seem like a possibility.
Working closely with Jeremiah we hope to help these women to continue to be komera!
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