Inshuti Mu Buzima

A few years ago, my friend Sloan gave me a copy of Mountains Beyond Mountains for my birthday. For anyone who hasn’t read it, the book tells the story of Dr. Paul Farmer, an MD and anthropologist who has dedicated his life to revolutionizing the way health care is delivered to the world’s poorest populations. Dr. Farmer began his work in Haiti, and Partners In Health, the organization he co-founded with some less-heralded but equally genius colleagues, has since expanded its reach Russia, Peru, Malawi, Lesotho, and Rwanda. In addition to convincing me of the saintliness of Paul Farmer, the book inspired and motivated me to serve abroad. Without it, I’m not sure I would have ended up in Rwanda.

Last Sunday, Julie and I drove out to visit the Inshuti Mu Buzima (Partners In Health in Kinyarwanda) hospital in Rwinkwavu, a rural sector about two hours outside of Kigali. The drive was familiar—on the roadside children lug small water jugs to or from the pump, miniature versions of the adults who carry larger jugs two at a time or push them slowly uphill on bicycles. The road passes through village after village, each with a handful of mud-brick facades nearly flush with the highway, most looking strangely stagnant, but not quite lifeless, as if everyone was just out on lunch break. I am often struck by how normal this has become for me to see, and how ridiculously cushy life is for me and most of my fellow Kigali-based ex-pats. We may have to filter our water, but it comes out of the faucet. In the house.

The point, though, is that PIH works where people are poor and access to services is limited—Rwinkwavu fits the bill. We were shown around the hospital and the rest of the campus by the assistant to the site director. We visited all of the hospital’s wards, saw doctors doing their rounds, and heard about the way PIH trains community health workers to monitor patients in their homes and spread health information. From my limited knowledge of public health, these trainings are what make PIH’s approach to rural health care so different, and, many might say, groundbreaking. The hospital currently has 800 trained health workers out in the district, each of whom is responsible for visiting 3 – 6 patients or families a day to ensure that prescribed meds are being taken, and to monitor the numerous variables that can affect a family’s well-being: food security, safe shelter, access to education for the children, etc. The hospital also has a pharmacy, operating room, a lab where they run tests for TB and HIV, and a set of its own ambulances. You don’t have to look at the before and after photos that are posted on the walls to know that the hospital and the system of health care outreach that its staff directs are immeasurable improvements over the services that existed before PIH’s arrival.

All over the PIH campus, I was struck by how appealing the physical space was. Not only were the grounds well maintained and clean, a concerted effort had clearly been made to add colorful, visually appealing vines, flowerbeds, and other greenery. According to the PIH employees who showed us around, this, like so many other aspects of PIH’s work, is a direct result of Paul Farmer’s unflagging commitment to the dignity of the individual: being poor, he says, shouldn’t condemn you to abysmal medical care provided in an equally abysmal setting. The result is a hospital with gardens like this one. Again, saintly.

Most satisfying about the trip was the realization that something that had so inspired me in print was even more inspirational in person. The story told in Mountains Beyond Mountains is so moving because Paul Farmer is portrayed trying to beat the odds, tirelessly serving a people the world had decided to ignore. In the book, Farmer and his small staff are on a shoestring budget, walking miles to visit their patients (the beginnings of the outreach program I just mentioned), begging donors in the US to pay for equipment and supplies for their new hospital, and constantly looking for ways to improve their new model of health care. Walking around the site at Rwinkwavu, in another country the world once ignored, the inspiration comes from knowing that PIH beat the odds, and that despite its increased global stature and budget, the essence and spirit of its remarkable original mission have not gotten lost in the shuffle at all.

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This was drawn in chalk on the patio at one of the staff houses.