Child Survival Project - Butare

In the Province of Butare in southern Rwanda, Concern is planning to implement a 5-year project titled the ‘Child Survival Project’ (CSP) with the goal to contribute to a sustainable reduction in maternal and child mortality and morbidity, and increased life expectancy in Kibilizi Health District (KHD). The physical area that is covered by KHD spans across two administrative districts, namely Kibingo District and Mugomwa District. These two districts are serviced by seven existing health centres, which will be the initial focus of Concern’s support.

At the time of our visit, the CSP was only just getting started; all case studies gathered are therefore intended as ‘baseline data’; informal interviews that show up some of the common health problems in the area. For further, more detailed, information the CSP proposal should be consulted, alongside the research material, which is currently being analysed.

Immunisation
One of the issues Concern’s CSP is hoping to tackle is the availability of outreach facilities. The seven health centres that make up KHD cover a vast area on land and in many cases the health centres are a long walk from the villages they service. As a result, preventative care suffers; parents find it too far to take their children to the HC for immunisations or the fact that an immunisation drive is being planned, simply doesn’t reach the most remote communities.

On the day of our visit, an ‘immunisation day’  was taking place in Fuji Sector *(or Fugi, both spellings are used). The health care staff were two nurses from Kigembe Health Centre in Kibingo District, who had been assisted with a Concern vehicle to get to Fuji to immunise all children under five. 

The importance of outreach becomes clear when you talk to mothers whose children have been vaccinated only during outreach sessions. Many simply cannot make it to the local HC for the repeated vaccinations a small baby needs in the first year of its life. An increase in child mortality because of lack of immunisation has been the result. A disruption of the outreach facilities has caused a drop in immunisation coverage, which was at a very high 87% in 1992 (before the war and genocide of 1994) and has now dropped to 76%.

Frodanata Uwizeyimana is 25 years old. She has two children and is from Nteko cellule**, one hour’s walk from Fuji Primary school where the immunisations are taking place. She has brought her two-week-old baby boy Mugisha along, who hasn’t yet been baptised and will be given a first name after the ceremony.

Frodanata explains that her baby was born at home, with the help of a traditional birth attendant (TBA). “There are many TBAs in my area, but this woman happens to be a neighbour, so she was the one who helped me with the birth. Everything went well, there were no complications.” Frodanata’s first child, a boy who is not six was born in a health centre, but that was when they lived in a refugee camp in Tanzania, so there were few other options. Frodanata and her husband fled Rwanda in 1994 and came back to the place where they were born and brought up in 1998. I asked her why she didn’t deliver her second child in the health centre.

“The health centre is very far away, I went into labour and I couldn’t walk all the way to Kigembe, it was too far, so I gave birth at home. I had been for a check up in the HC when I was 7 months pregnant and they told me to come back again a month later, but I was sick, so I didn’t go.”

“I had malaria in the 7th month of my pregnancy, I was worried that I would loose the baby, but luckily all went well. I didn’t go to the health centre to be treated because I had no money, a simple consultation can cost 1,000-1,500 Rwandan Francs, it is too expensive. If you are admitted and have to stay overnight, it can cost as much as 5,000 RFr. We live off cultivation; we have only a small plot of land so we rent another plot from a neighbour. We cultivate just enough to eat for ourselves. We sell the bananas that we grow and with the money we earn we pay off the landowner. A little bit of cash is left over for essentials like salt, sugar, soap etc.”

“It is hard to get by; my son is 6 years old now and we’ll send him to school in September. It will cost us 2,500 RFr for enrolment, and 100 RFr for each term after that. We also have to buy him books and a uniform. It is important that he goes to school, I completed 7th grade myself.” [7th grade means all of primary school and one year at secondary level]

“My eldest son got all his immunisations at the refugee camp in Tanzania; only polio drops he received when we got back to Rwanda. I think immunisation is important for a child; I would try to take my baby to Kigembe HC if there was no outreach here. At least I would try, I do the same when my children are sick; if we have money, I take them to the HC.”

“I think the care at the HC is fine, we are normally well received but the cost of the treatment and medicine is too high. Many people from my village don’t even go to the HC for a diagnosis just because they know they cannot afford the medicine. For the same reason most women deliver their babies at home. It cost too much to deliver at the clinic, most can’t afford it. And if you get complications and get transferred to the hospital in Butare, it is even more expensive! That is why most women rely on TBAs. Some TBAs charge for their help, but never more that 500 RFr, the TBA who helped me didn’t charge anything.”

“To be honest, I don’t know if the TBA who helped me was trained or not. There used to be a lot of trainings, I think. [No TBA trainings have taken place since 1994-this is one of the issues Concern is trying to look into, since 80.8% of all births in KHD take place at home] I don’t know many women who have had complications at birth, but sometimes you just don’t hear about that. Because of the distance, many people who are very sick simply die before they get to a health centre; not just with birth complications but other illnesses as well, especially malaria.”

“Yes malaria is a very big problem here. I had malaria three times in the past 12 months; once, as I said, in the 7th month of my pregnancy. When I get malaria I get high temperatures, a sour taste in my mouth, I shiver and vomit and can’t eat a thing. I usually just stay at home and wait until I get better. Sometimes I buy medicine from a pharmacy; I give money to someone who is travelling to Butare [nearest big town] and buy some medicine for 500 RFr. It only costs 150 RFr for each dose of malaria medicine, so it’s much cheaper than going to the health centre.”

“Two close relatives of mine died of malaria. My brother and my mother’s sister, it is a terrible illness and many people die of it.”

“We have no mosquito net here; you hear people talk about them on the radio all the time. We had a mosquito net in Tanzania, in the refugee camp, but we sold it on the way back. We were in need of cash, we had no food along the way, so all we could do was to sell our belongings; the mosquito net included. It worked very well; we had no malaria in the camp at all. I would like to have a net again, but we can’t afford to buy one, they are too expensive. I don’t know exactly how much, but I hear they cost a lot. If they cost around 1000 RFr we could buy one, but I don’t think they’re that cheap!

*A ‘sector’ is a typical Rwandan administrative unit. A sector is made up of 4-6 ‘cellules,’ which are the size of small villages or hamlets.

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