I didn’t expect the shower to be cold… but it was. For those of you who have lived in Africa, you are probably surprised at my American leanings. However, I have been back in the USA for two years and was kind of getting used to having warm showers every day. Ok, I lie, I have never had to take cold showers for any period of time more than a month in my life. The fact that the light trickle of parasite infused water also happens to be freezing makes me want to shower less often. Now I have relegated myself to sponge baths with a little bucket of tepid water.
I am living at the school of public health of the University of Rwanda except I am starting to think that no one attends this school. I see random people around, but I have no idea what anyone is doing. It doesn’t help that they are either speaking in Kinrwandan or French, neither of which are my specialties. I am learning a lot of French though and am already much improved in a weeks time. They have a place to eat here, where I eat breakfast and dinner, but I am usually the only one there, which is kind of weird.
My first few days here consisted of traveling around to most of the government offices in Kigali with Angelique, a Rwandan Ph.D student at Brandeis, trying to get approval for our project. We have already been approved and funded, but apparently Rwanda has a bunch of hoops through which one must jump if they want to collect data in the country. For example, CNLS, the AIDS branch of the government approved our project and gave us a letter. However, we are now supposed to get approval of the Ministry of Health, but they said they wont give it to us until the Bureau of Statistics approves our methodology. We are also supposed to get approval from the Ethics people. On top of that we sat in the Ministry of Health trying to get data on the country’s Community Based Health Insurance coverage only to be told a few hours later that they don’t have that data electronically. We started to look through stacks of randomly compiled papers only to realize that it was futile to try to compile data on all 393 health centers in Rwanda for July of 2006. Anyway, this all goes to show you the beauty of bureaucracy. There is no way I could do what Angelique does getting all these appointments–she literally knows someone at each government agency. We start going to health centers in a week most likely, barring any government intervention…
I have also been working on matching health centers from the intervention group with our control group, creating a questionnaire to evaluate integration of HIV/AIDS services and organizational efficiency, and refining and turning in my masters proposal. I will explain our study in as succinct a manner as possible…
We hypothesized that HIV/AIDS money, estimated $10 billion USD in 2007, is actually hurting the overall health system if it isn’t integrated with other health services. Initially, all HIV/AIDS money was put into stand alone centers that paid their staff much more than the country’s health system. Naturally, a lot of the talent of the country went to those projects, and in essence abandoned the overall health system. Rwanda made integration a law in 2006, so we are taking a cohort of health centers who implemented in 2004, 2006, and not at all and studying the differences between them. We are interested in issues of efficiency, the value of integration and resource diversion. Anyway, that is essentially my masters thesis…
I am also in the process of working out an internship for the other half of my time that isn’t on this project and it looks like it will either be Millennium Village Project’s AIDS tracking unit or UNAIDS doing research with them.
Rwandans love to make laws… Welcome to Socialism. No, not really, but they love laws. From motorcycle helmet laws to compulsory community service on the last Saturday of the month– usually fixing roads– Rwanda really stands apart from other African countries I have been to. I dont know if it is in a good way or not… no pictures yet… and no I haven’t seen the hotel.
