"What would make it easier for you to reveal your HIV status at boarding school?"

The session ended with the question, “What would make it easier for you reveal your HIV status at boarding school?”  Participants’ answers focused largely on education, with many revealing that they learned very little about HIV and AIDS from their school curriculum.  When asked how many of them learned about HIV in school, only 6 of 10 responded that they had.  The ones who had HIV education in school indicated that it was limited and that there was only a short paragraph explaining HIV/AIDS in the chapter under Sexually Transmitted Infections (STI).  They also reported that many of their teachers did not have adequate knowledge on the subject.  They emphasized that the school curriculum did a poor job of explaining the difference between HIV and AIDS (“being sick from HIV”).  They said that their classmates, friends and family often did not understand that people could live successful, healthy lives even if they were HIV positive.  The participants’ recommendations for this, aside from including more information about HIV in the school curriculum, was to have school representatives lecture briefly about HIV/AIDS at morning parade or in the dorm rooms to supplement their learning.

In addition, many participants agreed that telling at least one trustworthy school representative, whether it was a teacher, headmaster or matron, about their HIV status was important to remaining adherent.  School representatives could help provide safe spaces and times for students to take their HIV medication. In addition, when students needed to ask for time off from school to pick up their medications from clinic (since they are currently only able to get a one month’s supply), these representatives could allow them permission.  Other participants recommended telling friends at school so that they could remind and help them to take their medication.

Stigma and Dropping out of Boarding School

Another participant in our first focus group described a traumatic experience when his classmates found out that he was HIV positive.  When his friends saw him taking his medication and asked what it was, he would tell them that it was for a headache.  One day, one of his friends had a headache and went into the participant’s belongings and took one of his medications.  Afterwards, his friend felt dizzy and reported it to the headmaster.   The headmaster assumed that he had taken illicit drugs and asked where he had gotten the medication.  Then, the headmaster took the bottle of medication from that participant’s belongings and held it up in front of the entire school, asking who it belonged to.  The participant didn’t speak up but many of his classmates knew that it was his and some identified it as medication for HIV.  Soon, the whole school knew and the participant was humiliated and depressed.  He refused to leave his bed or go to class for several days.  When he finally did, he discovered that he was being barred from entering the classroom by school security until he turned over the rest of his medication.  He tried explaining what the medication was for and that he needed it, but the headmaster refused to let him return to class until he gave him turned in his medication.  So, the participant went to the police station and told them and the situation, disclosing his HIV status to one particular police officer.  The police officer told him that he would come to his school soon.  Three days later, a different police officer showed up at school and took him back to the police station.  During this time, many people in the police office also became aware that the participant was HIV positive.  Eventually the headmaster came to understand the participant’s situation, however, due to this experience and the discrimination that the participant was faced at his boarding school he transferred soon after.  Ultimately, he dropped out of boarding school and no longer attends school due to the extreme stigma that he faced from having HIV.

10 Fast Facts about Rwanda

1. Plastic bags are banned here.  They will even search your bags at the border and make you remove any that you try to bring into the country.

2. You can walk alone at night.  Kigali is relatively safer than its East African capital counterparts (Kampala, Nairobi, Dar) where I would never attempt to walk alone after the sun goes down.  

3. French is more widely spoken and written then English.  Thank you, Belgium.

4. The coffee is phenomenal.  Full stop.

5.  Tea is only drunk in the morning with breakfast.  No mid-day chai break here.

6. When trying to get your attention, Rwandans will "hiss" at you. No joke.

7.  Overcrowding is rarer on buses.  In Kigali, traffic police actually police the streets, especially around rush hour, and pull buses over if there is even one person more than there are seats.  Even the bus conductor, the guy collecting the money and hollaring out the bus's destination, must have a seat to himself.

8. While health insurance isn't mandatory, however, the government provides cost-effective, subsidized plans (called "Mutuelle de Sante," or "Mutuelle" for short) that range from free to $6/year and upwards, based on Income Level Category.

9.  Rwanda is in the UTC +2 time zone, or Central African Time.  Daylight savings time is not observed.

10.  Rwandas tell time in the "African way", adding or subtracting 6 to the time, depending on the hour.  Eg. 10am would be said as 4 o'clock in the morning in Kinyarwanda/Swahili while 12am would be said as 6 o'clock at night.

Clinic-wide Meeting

Last week, we had our scheduled meeting led by Dr. Gilbert, Edmond and myself with all the nurses, Abel and the psychosocial team to discuss the Family Needs Assessment.  My main agenda for the meeting was to get clarification as to why this data was collected and try to tease out nurses’ and counselors’ ideas on what information could help them practice better.  I know that we could make correlations from the data that we already had, however, I wanted to gain the team’s perspective to better direct my analysis and suggestions.  They answered my questions patiently (although it was 2:30-4 on a Thursday, so people were ready to go home) and we were able to determine several areas of focus for small group sessions.  These areas included substance abuse, child abuse, HIV stigma and being an orphan.  Edmond presented an explanation as to the current state of the government-funded social services in Rwanda and we discussed whether or not WE-ACTx would benefit from using these.  Since it looks like the funding is limited and most social services are only for temporary problems, there is not much support.  One option is to search for NGO’s addressing social issues preventing ARV adherence in Kigali and forming relationships with them.

In addition, we discussed whether or not it would be valuable to organize small focus groups of children under the age of 18.  It was agreed that children are more honest without their parents present and asking them about our four areas of focus in this setting could be very beneficial.

We all agreed that the next steps for the remaining 4 weeks are to determine children for the focus groups and perform the sessions in Kinyarwanda.  To do this, we will need a psychosocial counselor, either Laetty or Henriette, present in addition to a translator. 

Since all the counselors are off work this week for a training, I spent my time composing a list of Focus Group questions, translating the remainder of the speadsheet data with Augustin and arranging a meeting for next week.  In the meantime, I began working with our data analyst, Jackie, to gather data on patients that we still need viral loads for in order to use it for any correlations or deductions regarding ARV adherence.

Happy Independence Day, Rwanda!

This is the agenda I composed for our meeting.

Laundry

I tried to wash my own laudry this morning.  Josie, one of our housemaids, was out visiting the doctor for her cough.  Going on a long hike this weekend, I needed my clothes washed and dried by tonight in order to pack them.  With the sun as the only form of a dryer, I knew that the clothes needed to be washed and hung by midday in order to dry in time.  As I paraded my clothes through the kitchen and dumped them into the cement basin, Serafine (our cook) followed curiously.  No sooner had I turned on the water and made my way towards the shed in search of laundry detergent than I heard my name repeated in haste.  

"Stephanie!  Stephanie!"  Serafine called out.

"Abey?" I inquired back in Swahili.

"I will do it."  She said and without asking her what, I knew exactly to what she was referring.

"No, no, no. I can wash my own clothes," I insisted.  "I know how to do it," I said as I wandered back over to the tub filled with my clothes.

"Oya!" she exclamed, switching to Kinyarwanda to emphasize the "no!"

"Serafiiiiiiiine..." I pleaded.

She went in search of the laundry detergent as I placed my clothes in the basin and let them soak up the cool water.  After finding no detergent, Serafine sprayed in dish soap instead and I swoshed it around with my undies, shirts and bras.

"Leave it.  I will do it," she repeated.

I tried again to wash my own clothes, begging and explaining to her why I wanted I was insisting on doing Josie's job.  As I began scrubbing one of my orange sports bras, she put her arms around my waist, pulling me in for a hug.

"Leave.  We will do it."  A victim of her loving embrace and relentless insistance, I pulled my hands from the soapy water and back away.

"Okay.  Thank you."  Slowly, I walked guilitily away.

She is certainly a wonderful mother and the most strong of women, so I had to respect her commands.  Later, when I asked her for a picture to add to this story, these resulted(per her idea...):

I promise that I'm laughing...not scared. :)

Climbing Mt. Kigali

On Sunday, Lizzy and I decided to be explorative.  We set our sights on climbing to the top of Mt. Kigali, a pretty little bump in the wavy landscape surrounding Kigali town.  Seen here in the background from our clinic, it was about a 20 minute bus ride from the bus station in the middle of town, Mimoji, which is about a 30 minute walk from our house.  After hopping off somewhere close to the base of the mountain, we began winding our way through narrowing streets, eventually walking next houses (or sometimes into them).  Children would wander after us and peter off after a few minutes.  Eventually a teenage girl jokingly offered us some of the corn that she was eating and, sticking my hand into her yard, happily accepted it.  Munching and meandering, we made our way up and up and up.  After about 45 minutes of attempting to find a path to the forest that topped the mountain, we came across a promising one.  Barely visible but still frequently trodden, we crunched our way through the leaf-covered ground, sliding backwards on the tiny rocks and layers of leaves. 

View just after passing by the last of the houses.

 As we climbed, the herd of children and teens following us morphed into only two boys (11 and 12 years old) and one kid named Erik (22 years old).  Between our blind intuition and the three of them, we pieced together a path to the peak.  As the top, we crossed a dirt road, passing by some guys leaned against tree trunks and another chatting it up on his phone.  After 50 meters, the forest opened up into a vast, cascading plain allowing glimpses of the mountains that sprung up between the road to Gisenyi in the West.  Barely visible along the skyline was a double peaked mountain that contained a volcano in Virunga National Park in the DRC.  We relaxed, shared some biscuits and took some jumping photos.  We are wazungu after all!

The hike down took about an hour and was punctuated by Lizzy's first taste of sugar cane.  We bought a whole branch for 100Rfr (15 cents) and gave some to the boys, Erik, and one of his friends that passed by.  The mama selling it laughed as we attempted to eat the sugar cane as readily of our Rwandan company and agreed to take a photo with these highly  incompetent wazungu.

The day ended with us exhausted, a bit sunburnt and hopping on motos as we waved goodbye to our new friends and sped home for water and libations.  

Worthwhile random adventure!