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Wednesday, June 24, 2015

Rainbow Platforms, Monochrome Regimes

From originating couples’ testing a standard of care to initiating HIV vaccine research in Rwanda, PSF has a habit of breaking ground.  I guess it shouldn’t be a surprise that Rwanda’s first-ever survey of MSM* was also conducted by PSF just this past year.  I’m beyond excited.  While I’m not directly involved in the MSM study, I’m extremely proud to be working with an organization that is engaging with LGBTQ health in Africa.  It’s a difficult subject, one fraught with political peril, and something I’ve been interested in since I was undergraduate.

In the countries surrounding Rwanda, same-sex sexual activity is punishable by several years’ imprisonment, life imprisonment, corporal punishment, or death.  By contrast, the Rwandan government has not created any legislation explicitly criminalizing homosexuality.  Instead, the official policy is one of complete denial.  When PSF approached the Rwandan Biomedical Committee with their proposal for MSM research, they were given permission to proceed, but they were also laughingly told that they wouldn’t find any MSM in Rwanda.  Since then, more than 1,000 men have been interviewed and about 400 study participants have been enrolled. The goal of the study is just to get a handle on MSM networks and health behaviors while providing STI testing and some basic health services, but it will serve as groundwork for broader initiatives in the future.

I knew the study was going on but I didn’t meet the MSM research team until just last week.  The founder of PSF arrived from Zambia to check on our progress and brought with her a young man I’ll refer to as David.  David is a Zambian activist for LGBTQ rights.  He works with an NGO that promotes LGBTQ health and supports what he referred to as the “rainbow platform,” candidates who run for public office in Zambia with the explicit intent to de-criminalize homosexuality nationwide.  The night he arrived we all had dinner – him, the MSM study team, the founder of PSF, several other senior staff, the other summer interns and myself – and we talked uninhibited about our mutual ambition to bring the issue of LGBTQ health to light in southeastern Africa.  As Peace Corps Volunteer, I sat on my opinions about homosexuality for fear of alienating myself from people in my village.  Talking to David, I felt as if five years’ worth of weight was being lifted.

Before leaving PSF the following Thursday, David made a small speech to express his thanks.  He said he had come to Rwanda to learn how PSF is engaging with the issue of LGBTQ stigmatization and persecution and that he is excited by the work we are doing.  He said, “In Africa, many people think that the HIV epidemic can be stopped by simply treating members of the ‘general population’ – the heterosexual population – and that the rest of us can be ignored because we are a minority. But the situation is more fluid than that. There are married men who are also members of our community.  There are people who move in and out of our community.  We are not an isolated group – we are part of the population too, and if you don’t attend the needs of MSM and other LGBTQ people, you may as well do nothing at all.”

I couldn't have said it better.

*MSM stands for “men who have sex with men.” While the terms “gay” and “homosexual” may be commonplace in the U.S., such terms carry little meaning in countries where homosexuality is neither condoned nor acknowledged, and where gay culture and networks remain thoroughly underground.  Furthermore, in public health research, sexual behaviors often take primacy over how a person identifies because behaviors directly cause things like the transmission of HIV. 

Monday, June 15, 2015

The Bus Incident

This summer I’m sharing a PSF-owned house with two other MPH students, Kristina and Tiffany, and a fourth-year med student, Eli.  We recently received another housemate, Bromley, whose dad used to work in administration with PSF.  She’s only sixteen, but thanks to her family contacts and a lot of gumption on her part, she is building her nascent resume at Rwandan clinics. She says she wants to get her MPH someday.  I don’t think she’s going to have any trouble doing so.

Eli is a new addition to our group – he only arrived this week – but the rest of us have become a pretty tight team, especially when it comes to planning our weekends.  So far we’ve explored Volcanoes National Park, braved the open-air market at Kimironko, and sought out Kigali’s best restaurants.  This past weekend, though, was a different kind of adventure.

It started uneventfully.  We decided to take a trip to the western province to check out Lake Kivu, a pristine freshwater lake nestled between northwestern Rwanda and eastern Congo. We set out Saturday morning by bus and arrived before 4pm at Home St. Jean, a beautiful little hostel overlooking the lake. For $14 each, we got clean rooms for the night with private toilets, hot showers and complimentary soap. The restaurant service was a little slow, but otherwise we had no complaints.  We had found heaven on earth for an obscenely reasonable price.

The next morning we took a boat to Amahoro Island and back before hopping a bus to Kigali. We were dusty and tired, but happy.  We settled in for the three-hour ride home.

Then, about an hour into our trip, the bus stalled and steam started gushing from under the hood. No one seemed perturbed – breakdowns happen often in Rwanda. The driver pulled over and hopped out to inspect the damage while passengers dug out their cell phones to let their friends and family know about the delay. The driver had his phone out too, and I assumed he was calling another vehicle to come pick us up – until I heard him say, “Urazanye amazi!” Bring water?  Really? He expected us to make it to Kigali with a busted radiator? I started to ask the people around me if this really was the plan.  Meanwhile, the driver was poking the floor with a stick and steam had started to fill the front end of the bus, slowly at first, and then…

BOOM. Something burst, and a brownish jet of hot water shot up through the floor. A woman screamed, and suddenly there was mass panic.  Passengers started shoving each other to the ground in an effort to get out the door. I tossed my backpack out the window and started trying to climb out after it, but my shirt snagged on something and I left dangling halfway out the window screaming “STOP STOP STOP” while people shoved me from behind. Kristina was in the back of the bus with her hands over her head. Tiffany leapt out a window on the other side. Bromley, the only sane one among us, had recovered Tiffany’s iPhone before making her way calmly out the side door. I think everyone – myself included – had assumed the whole bus was going to blow.

When the dust cleared, it became apparent that the panic was causeless.  I don’t know enough about buses to explain the jet of water (respond in the comments section, please?) but it turned out that all the driver needed to do was release some pressure that had built up in the cooling system and send for a jerry can to replenish the water that was lost. Less than an hour later, we were all back in the bus and headed home.  We made it to Kigali without further incident.

Back at the house we recounted what happened to Eli and laughed until we cried.  I really couldn’t have asked for better travel companions.  A lesser group would take a break from weekend travel, but not us.  We’re already gearing up for our next adventure.

Akagera Park, anyone?

Tuesday, June 9, 2015

Stories in the Data

I’ve been trying for a couple of weeks now to write a compelling post about working for an international nonprofit. The issue isn't that I don't have material; our data speak volumes about peoples' lives here, and every single thing we collect - every survey, every blood sample - tells a unique and often harrowing story. In the questionnaires alone, we can see stories of young couples struggling to make ends meet, couples who walk an hour or more to get to a clinic that provides family planning services, who are raising small children and holding down multiple jobs despite being sick with HIV. In the data we can see stories of thirty-year relationships potentially ruined by infidelity, but more often than that, we see stories of couples who dutifully get tested for HIV on a regular basis, perhaps even annually, but forgo modern contraceptives. I want to talk about individual stories that have emerged from the surveys and lab but I don't want to publicly reveal too much about our research. Sometimes I also struggle to capture raw feelings and thoughts when I'm writing after sending a series of work emails. But I will continue to post, and hopefully some of it will be worth reading.

If there’s one insight worth sharing from the past three weeks, it’s that international nonprofit work and Peace Corps Service aren’t as different as one might think. Projet San Francisco is exceptionally well-organized for an operation its size - internally it is a well-oiled machine - but it is still subject to all the same infrastructural shortcomings and administrative inefficiencies as every other Kigali-based organization. Sometimes the power cuts out. Sometimes the internet doesn’t work. Sometimes things don’t happen on schedule. Sometimes surveys collected from the clinics are missing essential information because everything is painstakingly recorded by hand in multiple languages. Most of the time, things work quite well, and it’s nothing short of miraculous.

This week I will be helping develop a plan for study enrollment. I will be working with Robertine, a formidable woman with such a breadth of responsibilities at PSF, I'm not sure of her job title. She is primarily responsible for working with the nurses who provide couples' counseling and contraceptive promotion services at different clinics. Her counterpart is Jeannine, who basically runs the administrative office and ensures that data collection goes smoothly.  I'm excited to spend more time with them in the coming weeks.  Not only are they incredible at what they do, but they are some of the kindest people I've ever had the privilege of meeting.

More stories from the field forthcoming.  For now, I'm signing off.

Monday, May 25, 2015


I visited my old Peace Corps site over the weekend.  I took a twegerane to Nyabugogo, Kigali’s main bus park, and bought a ticket for a southbound bus.  As I boarded, three different scenarios ran through my head.  I’d show up and the whole village would look different, no one I knew would live there anymore, the Peace Corps would have discontinued my site and the whole visit would be nightmarish and disorienting.  Or I’d show up and things would be even more beautiful than I remembered, I would be welcomed with open arms, an impromptu celebration would be thrown in my honor, tears of joy would be shed, the new PCV would be beside herself to meet Gihara’s inaugural volunteer.  Or I’d show up and it would be as if I’d never left. I put in my headphones and watched a familiar stretch of countryside swish past, my heart pounding in my throat. 

When I arrived, the reality I found was mixed.  The village was largely unchanged.  It was market day, and the same vendors who used to sell me fruits and vegetables had laid out their usual spread.  People waved to me and called my name as if I’d returned from a weekend vacation.  I found a new storefront had emerged among the tea shops.  A giant icon of Jesus had been erected in front of the convent where I used to live – so huge, I thought for a horrifying moment that the convent was gone – but when I rounded the corner, the familiar green gate was still standing. 

The nuns I used to live with were no longer there.  New faces had taken their place.  Sister Donatile and Sister Amarita have been permanently relocated to some other country – the Central African Republic, if I understood correctly – by some authority in the diocese. Sister Mediatrice left Gihara to pursue a degree.  Sister Marie Rose is still based in Gihara, but she was gone for the weekend.  I was still greeted warmly and invited to have lunch at the convent, but I felt a little like I’d come home from summer camp to an empty house.

Leaving the convent, I wandered off into the hills to look for familiar faces. My goal was to find Annoncée’s house.  I’d been there so many times I was sure I could find the road, but new houses had sprung up all over my route and I got thoroughly lost.  I fell back on a village habit and started asking all the children I encountered if they knew Umwarimu Annoncée, eventually gathering a sizeable party.  So it was that I and about half a dozen children showed up in her front yard.

Before I had time to wonder if she’d remember me, she ran outside and threw her arms around me, literally lifting me up into the air.  She said, “Long time!” Finally, someone who felt the same way I did.  I asked her about the school where we used to teach together.  Apparently Peace Corps discontinued the site – the school has not received any new volunteers.  My former students are now in their final year of secondary.  Otherwise, things are unchanged.

I left Gihara feeling dusty and exhausted.  Back in the capital, I’m scrolling through the phone numbers I’ve amassed.  I didn’t find Louise, my best Gihara friend, nor did I find her number.  I have a few phone numbers for people who might be able to find her, though.  I’m thinking this is how I’m going to spend my weekends – tracking down old friends.

Outside, rain is pounding the walls of the house.  It makes me think of the dry season and how unsettled I would get when the rain tankard ran low.  It would get so dry that honey bees would gather around the spigot searching for droplets.  I always wondered what would happen if the water ran out completely, but I never got a chance to find out.  Just when things would start to seem desperate, the sky would open up like a tap and release a deafening torrent.  Rain would hammer the tin roofs and flood the gutters.  Every time, it felt like a prayer miraculously answered.  Rain still sounds like that to me – like a gift from God.

For the first time since the plane touched down, I feel a sense of relief.

Friday, May 22, 2015

Strange Homecoming

Muraho bose! I’m reviving my Peace Corps blog to bring you more stories from Rwanda.  As of my last post, I had just returned home to California.  I had begun studying for the GRE and initiated the long process of cultural reintegration.  I remember feeling good, if a little unsteady. 

A lot has happened since then.  Two jobs, one volunteering stint with Planned Parenthood, six master’s program applications, five acceptances and one year of grad school later, I have returned to Rwanda to begin a summer internship with the Rwanda Zambia HIV Research Group (an awesome organization – read more about them here).  I will be conducting research to improve the provision of long-acting reversible contraceptives to couples who do not want more children, or who want to wait at least three years to have more children.  In a country as densely populated as Rwanda – to the extent that arable farmland here literally cannot produce enough food to support the existing population – modern contraceptives are extremely important.  Long-acting reversible contraceptives are great because they’re effective even in the event of a supply chain interruption.* I’m so happy to be here. I’ve been hoping to do exactly this kind of work ever since I found a copy of Half the Sky lying around the Peace Corps office in Kigali.  I never dreamt I’d end up returning to Rwanda for this, but here I am.

Nothing is ever quite as expected.  I thought landing in Kigali would be an adrenaline rush, but something even more unsettling happened.  When we touched down, I looked out the window and thought, “Oh good.  I’m finally home.”

*Oral contraceptives and injectables, though popular in Rwanda, are less effective than long-term reversible contraceptives simply because they have to be used on a regular basis.  If a clinic runs out of IUDs, the women currently using them won’t have any problems, but if a clinic runs out of birth control pills, it’s a whole different story.