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Rwanda's new hospital & hope

April 2011
Burera District, RwandaWant to embed this video?
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We’re here to help support the government implement their roadmap and do it effectively and they gave us the space to try new things and to innovate.”
A baby boy, just 10 minutes old, lies on a small bed gasping for air. Despite his strained breathing, he’s alive and well.

That may not have been the case if his mother had not been brought to the new Butaro Hospital in one of Rwanda’s most remote districts. In fact he’s the very first baby born here.

While his mother was in labor, her unborn child had shown signs of respiratory distress: a major problem if the delivery had taken place at home or in a rural health center.

Instead, mother and unborn baby were brought to the hospital, where trained staff and quality equipment ensured their safety.

Dr. Agnes Binagwaho, Rwanda’s Permanent Secretary of Health, is passionate about improving maternal health in her country. But Rwanda still has a long way to go. “There are too many deaths that we could prevent by increasing access to care in a geographic way,” she says, “and also increasing the expertise of health professionals that deliver services, but also the number of health professionals.”

This is what the Butaro Hospital was built for: to provide quality health care that has been lacking in Burera District, which just a few years ago only had one doctor for its 340,000 people.

The spotless facility stands on top of a hill with views of Rwanda’s lush valleys. It’s a beacon of hope in a country with many scars. But the government couldn’t have done it without the help of others.

The U.S.-based nonprofit Partners in Health, which has built hospitals and clinics throughout the developing world, provided expertise and paid more than $4 million for the construction.

The Clinton Foundation also provided support, while the Rwandan government covered the cost of the hospital equipment.

Dr. Peter Drobac, the Country Director for Partners in Health here, says the alliance has worked extremely well. “I think it really represents the way partnerships, public-private partnerships for development, should work. We’re here to help support the government implement their roadmap and do it effectively and they gave us the space to try new things and to innovate.”

The innovation includes effective but inexpensive design features that can be replicated across the developing world.

People gather in the open air instead of confined corridors where diseases like tuberculosis can spread.

In the wards, every detail from the smooth resin on the floor that is easily sterilized, to the type of ceiling, has been carefully considered.

“The ceilings are high and vaulted and at the upper level there are these non-operable louvered windows and that allows air to pass up and out. It’s something called stack-effect ventilation,” says Drobac. “Heat rises naturally so air rises up and it’s continually passing out.”

Floating above Drobac is a large fan that spins slowly and silently while circulating air up and out of the windows. There are also ultraviolet lights that kill TB bacteria and other microbes in the air.

“Those things,” says Drobac, “collectively can actually achieve the same degree of ventilation and infection control as we do in United States hospitals at a fraction of the cost.”

And cost is key in a country like Rwanda, which is still recovering from the 1994 genocide that left an estimated 800,000 people dead.

In order to heal, and develop a better health system, the government is implementing a pyramid-based structure with the district hospital at the top.

At the base level, every village has at least two community health workers. They’re the first link in a chain that connects the villages with the health centers, and the centers with the hospital.

They’re trusted members of the community with rudimentary training to monitor those on medication and spot possible cases of common conditions like HIV, TB, malaria and malnutrition.

If there’s a serious case that cannot be treated at the community level, the patient is referred to the hospital.

For maternal health, the strategy is having a major impact. Until recently most women in Rwanda gave birth at home with no trained health providers on hand. In too many cases a complication resulted in the death of the baby and sometimes the mother as well.

Now, the community workers encourage women to give birth in the nearest health center, which has trained staff who can handle routine deliveries. If there’s a problem, they send the patient to the hospital.

This strategy has drastically reduced maternal mortality in a country with one of the worst records in the world.

“A couple of years ago we had eight deaths a day in Rwanda, and now we are at less than one death a day,” says Agnes Binagwaho, the Permanent Secretary of Health. “Even it’s too much, but that means there’s progress, but we should reach the point where we have zero deaths that we can prevent.”

Had it not been for the new procedures in Burera, a remarkable birth of quadruplets 16 months ago would probably have ended in tragedy.

When Angelique Mukazigama was in labor she thought she was just carrying twins.

Fearing complications, she was taken to the temporary Butaro Hospital, which handled difficult cases while the new hospital was being built. Converted from an old health center, the facility was basic, but it had doctors and trained staff.

After delivering the first two babies, they discovered there was a third. And then, another surprise, not just for the mother, but the doctor as well.

“When I did the last examination in order to deliver the placenta,” explains Dr. Juvenal Musavuli, “I realized that there were two feet – two other feet. Then it was very exciting. We called all the authorities for the hospital and finally the last one came – the fourth baby. It was very exciting and I think it’s one of my best days.”

The days for the doctors and patients should get better still.

Many jobs have been created and new skills learned in a community that built Butaro Hospital on a firm foundation.

The outer walls are made of local volcanic rock, signifying renewal from a tempestuous past.

Inside those walls, preparations are underway for the first Caesarean section. All while the first baby born here lies peacefully nearby, oblivious to the people and machines that are keeping him warm and helping him breath.

But as he grows, his aspirations will be much like the Butaro Hospital itself: to breathe, walk and run independently.
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