The Remera Hospital

The Remera hospital was several miles down a dirt road off the main highway from Kigali to Butare, the second largest city in Rwanda. The hospital was a nice but simple structure on well-kept grounds surrounded by a fence. It reminded me of the simple brick one story schools I had attended in Louisiana, with the large windows in every room, and courtyards between the wings of the building. As we waited in the courtyard to meet with the hospital director, we saw several ladies seated on benches in the courtyard. We learned that these were ladies from the district awaiting their HIV treatment.

The hospital director met us for about 15-20 minutes before giving us a tour of the hospital. He told us that this hospital served a population of 300,000 people in the Remera district. Incredibly, this population was served by only two doctors and four nurses at the hospital. There were more trained nurses in the district, but the wages were so low that most nurses chose to return home after their schooling and work in the fields, as they could better support their families this way compared to the wages of the nurses.

We learned that the hospital at Remera served three major needs. First, about half of their patients were HIV/AIDS patients. Another quarter of the patients were maternity patients, and the final quarter was for everything else from pediatrics to surgery to infectious diseases. The director told us that a major source of funding for the hospital came from the Bush AIDS initiative. The AIDS program paid for 3 of the 4 nurses at the Remera Hospital. Before the AIDS program started in 2002, over 10% of the population in the Remera district had HIV/AIDS. In just 7 years, the HIV/AIDS infection rate was reduced to 3% of the population. The director said that if similar progress could be made over the next 7 years, the infection rate could be reduced to levels comparable to the West. Further, prior to the program over two-thirds of the babies born to HIV infected mothers were themselves infected with HIV. Now, less than 5% of the babies born to HIV-infected mothers have HIV. That level of progress was stunning. The director said that they had tried to obtain funding over the years for all reasons from many sources. HIV/AIDS is the one and only program where the hospital has been able obtain outside funding.

I asked the director what reporting requirements the hospital had to retain the HIV/AIDS funding. I was curious what level of accountability was required to retain the funds. Indeed, the director said that reporting for the HIV/AIDS funding program was relatively strenuous. The hospital was required to show progress and meet pre-set medical criteria to continue the funding. I was glad that US funding for these HIV/AIDS programs was being so effective, and I was glad that those receiving the aid were being held to progress and performance standards. We all agreed that this was a very effective program, and the director said he truly did not know what they would do without the aid.

As we toured the hospital, we noted that they did not have any critical care patients. We asked what happened to their AIDS patients when their disease progressed to its final stages. The director said that when the disease reached the stage where effective care could not be provided by the hospital, the patients were sent home with family to die. In the entire country of Rwanda, Felix and the hospital director could only think of two hospices, both church-run. We discussed this situation further at lunch, and the hospital began to consider starting an AIDS hospice on-site. They had room on the current compound, and agreed that this perhaps should be a long-term goal.

Our group gained quite a bit of attention as we toured the hospital. We took pictures of the children in the pediatric care area. They were all so cute, and we showed the children and their mothers the pictures. They loved seeing themselves, and the mothers soon began bringing us their babies to take their pictures. It was fun to see their smiles and the joy in their eyes when they saw themselves in the pictures. The pictures I have of the children at that hospital are some of the most precious of my trip. The joy in their smiles was universally understood regardless of the language spoken.

One of the young lady patients came up to me and said in Kinyarwanda that while I was white on the outside, but I must be black on the inside because I had come there to see them and that I cared about them. There were others that had done far, far more for them than me, but I was glad to know that American money was making a big difference in the lives of the people of the Remera district.