Shake Hands with the Devil

Sitting at the top of the beautifully constructed public library which has a trendy ‘Innovation space’ and café at the top serving coffee, pastries and delicious mediterranean food – it’s difficult to imagine that I’m in the same country as the one depicted in the news stories, films and literature that emerged from the 1994 Genocide against the Tutsi.

To define this amazing country by the events of 1994 (which, sadly, is still too often the first thought in peoples’ minds when you mention Rwanda) would be a travesty. Rwanda has moved forwards with unbelievable grace and success; there is so much more to discover here than horror stories and memorials. From the breathtaking volcanic hills surrounding Lake Kivu, to the dense jungle revealing mountain gorillas, to the classy restaurants and not so classy nightclubs of Kigali – Rwanda has so much to offer. In fact Kigali was recently voted the most beautiful city in Africa by the United Nations! However, to forget about what happened here would also be a travesty, and it is impossible to deny the legacy left behind by the Genocide.

Any visit to Rwanda should include the Genocide memorial museum in Kigali. There are no words to describe the experience and I won’t attempt to. Suffice to say one feels confronted with the darkest possible side of humanity. Not only does the memorial act as a museum, it is also the burial site of 250,000 genocide victims and serves as an important space for loved ones to come to remember and reflect. It is maintained and run by the Aegis Trust – https://www.aegistrust.org/

This fantastic organisation treats genocide and crimes against humanity as a public health problem and use a specific prevention model:

Phase One: Primary Prevention

Research, remembrance and learning about the past, creating community resilience against the risk of genocide in the future

Phase Two: Secondary Prevention
Evidence-based campaigns to stop mass atrocities in the present

Phase Three: Tertiary prevention
Supporting survivors and communities to rebuild when genocide is past

Their work in Rwanda has included a peace building education programme reaching many thousands of young Rwandans and helping them to understand what happened and how such a tragedy could be prevented in the future.

The organisation also currently operates in South Sudan and Central African Republic  (where mass atrocities have left 5,000 dead and over a million more displaced thanks to divided religious communities).

Part of moving forwards requires looking back at the past in order to  make sense of what happened and learn from the mistakes that were made. I have just finished reading Romeo Dallaire’s book –

‘Shake Hands with the Devil’.

It doesn’t make for a particularly enjoyable read, and I felt that there was a  somewhat defensive tone throughout the book. Nevertheless, its undoubtedly an essential text for anyone wanting to understand the failures of the UN peacekeeping mission in Rwanda during the Genocide. The true extent of the international community’s indifference to the thousands of Rwandan lives that were being lost is beyond shocking. As Ban Ki Moon recently stated “We could have, and should have, done more”. The subsequent influx of foreign money that followed 1994 was no surprise. But, as Lt. Gen. Dallaire points out in his account – no amount of aid money will ever be able to make up for the way in which America and the U.K. turned their backs on Rwanda.

If there are any lessons we can take from this, perhaps it should be that never again should we allow our governments to determine that some lives are worth more than others.

24hrs in DRC

This weekend I was lucky enough to hike up Mount Nyiragongo -Africa’s most active volcano. It also happens to be located close to Goma, in the Democratic Republic of Congo – which adds a certain extra ‘spice’ to the experience.

Having spent only 24 hrs in the country, most of which was spent well out of harm’s way at an altitude of 3,600m, I can’t pretend to have been able to form any real impression of what it must be like to live in the area – one  of the most unstable parts of the country thanks to rebel militias backed by Uganda and Rwanda.

But the difference between Gisenyi (it’s neighbouring town across the border in Rwanda) was striking. One moment you are strolling down peaceful, palm tree lined boulevards (with an almost riviera-like feel), admiring the sandy beaches of Lake Kivu. The next, you are holding on for dear life in the back of a 4×4 navigating dirt tracks littered with pot holes, in amidst large UN trucks carrying stern looking peace keeping troops. The buildings are covered in barbed wire, and young guys dressed in camouflage sit around holding rather large weapons. In amongst these bleak images, you are greeted by the chaos of normal daily life.  There is a warmth and a liveliness to the city that makes you feel at ease, despite all the horror stories you may have read. Not to mention the sense of humour of almost everyone you meet (except a few grumpy border officials – though in my experience some sweet talking in French soon turns them into your new best friend!).

The hike up the volcano itself was sensational. Led by our two wonderful guides (who between them had degrees in International Relations and Law) we made it through a vicious rainstorm to the crater summit and spent the next few hours absolutely mesmerised by the lava lake:

Inevitably, getting up at 5am to watch the sun rise over the Virunga National Park lends itself to some contemplative thought.

As volcanic craters rise through the mist, one is struck by the sense that there are few places in the world as beautiful or as complex.

Joseph Conrad’s ‘Heart of Darkness’ whilst outdated, still manages to paint a captivating picture of the Congo.

For a more up to date, factual account, Michela Wrong’s ‘In the Footsteps of Mr. Kurtz’ describes life under the Mobutu regime and I would highly recommend it to anyone interested in learning more about the country.

Tim Butcher’s ‘Blood River’ is another gripping book detailing his retracing of Stanley’s expedition along the Congo River in the modern day.

Finally, Barbarah Kingsolver’s ‘The Poisonwood Bible’ focuses on one family’s experience of life in the Congo.

A common theme running through all of these accounts (and I’m sure many others), is the pure cruelty of the Belgian colonists who ran the country until its independence in the 1960’s. It is unsurprising that the country descended into civil war following independence, given that under Belgian colonial rule, no Congolese child above the age of 12 was allowed to go to school. When the Belgians left, there was practically no one in the country who had the skills required to run it. This is just one small example that gives us a clue as to how the country ended up in its current state.

Furthermore, during the Rwandan genocide in 1994, there was mass displacement of Hutu people (both innocent refugees and not so innocent militia) into neighbouring countries – namely DRC and Uganda. Despite repeated warnings from the UNAMIR commander at the time (Romeo Dallaire) that unless steps were taken to address this (by providing safe zones and humanitarian assistance to these people inside of Rwanda), it would destabilise the entire region, the international community ignored him. Lo, and behold – over a decade later the DRC is plagued with unrest. Acts of violence including killing, rape and looting carried out by armed rebel groups continue against civilians, despite the heavy presence of the UN and the Congolese army.

And yet, it is easy for the world to turn its back and dismiss the country as a hopeless case, without stopping for a moment to think about the responsibility the western world had in creating the perfect conditions for war to flourish.

To end on a happy note, I was assured by Ali, our lead guide, that since 2013 the country has been calm and stable (a slightly different story to the travel advice from the U.K. foreign office – I’ll leave it up to you to decide which is more reliable!).  The hike was one of the best trips I have ever done, and I would encourage anyone with the opportunity to go for it.

It is truly a beautiful place and perhaps the more people that show an interest in visiting, the more of an incentive there will be to ensure that stability and security prevail.

Africa Yoga Project

After a “stressful” day spent navigating the city on the back of a moto, what better way to re-find that inner zen than with some evening yoga classes.

One of my favourite things to do here is head over to the Inema Arts Centre (an awesome space founded by brothers and self-taught painters Emmanuel Nkuranga and Innocent Nkurunziza: http://inemaartcenter.com/) for the yoga classes run by Yego Yoga Rwanda.

Many of the instructors there have been trained through the Africa Yoga Project  http://www.africayogaproject.org/.

The AYP is dedicated to delivering all that Yoga has to offer to diverse communities throughout East Africa. It’s more than just physical strength and relaxation. AYP promotes yoga practice, meditation and performing arts as a vehicle for empowerment, health education, relationship building and community activism; AYP teachers work in prisons, HIV/AIDS support groups, special needs centres, deaf schools and rural villages.

They provide 300 free classes every week and have trained 100 teachers so far, generating employment and local business as a result.

It may seem ridiculous to be writing about yoga – isn’t it somewhat of a luxury?

But why shouldn’t people living in difficult and sometimes desperate conditions be offered the chance to develop emotional and physical wellbeing?  In fact, surely it is exactly these communities who stand to benefit the most. Since introducing its classes in some of the poorest areas of Kenya in 2007, AYP has witnessed the transformational power of yoga practice. It has brought emotional healing and personal strength to individuals, opened up channels of communication within communities and inspired a new vision of what the future could look like.

Taking HIV/AIDs as an example, depression and stigmatisation amongst young people living with HIV is ubiquitous. And whilst food, education and healthcare are absolutely essential, they are redundant if personal wellbeing and happiness is not also addressed. Nurturing your soul and your emotional wellbeing should be a right, not a luxury. Everyone deserves the chance to feel happy and at peace within themselves.

Umuganda

Today, is Umuganda day! Umuganda can be loosely translated to mean ‘coming together in common purpose to achieve an outcome’. Every last Saturday of the month, all able-bodied Rwandans (between the age of 18 and 65) participate in mandatory community service from 08.00 am -12.00pm. Shops close, public transport is limited and all over the country neighbourhoods come together to address the particular needs of their community – be it planting trees, sweeping the streets, cutting grass, repairing public facilities or building homes for more vulnerable members.

The practical and economic benefits of umuganda are clear (the value of umuganda to the country’s development since 2007 is estimated at more than $60 million USD); but more importantly than that, umuganda builds cohesion and cooperation within communities. Neighbours from different backgrounds and different socioeconomic levels work together, providing everyone with a chance to have their voice heard.

Even the president joins in!   http://www.newtimes.co.rw/section/article/2015-11-01/194003/

Bringing people together in this way has been an integral part of rebuilding communities in Rwanda – nurturing a shared national identity that transcends old divisions.

Just imagine what could be achieved in our own countries by adopting such a practice. At a time when the news back home seems to be full  of hatred, division and prejudice, I think we could all learn a lot from the people of Rwanda.

YBank

What am I actually doing here?

Well, about a year ago I found out about an amazing sounding project called YBank.  A few emails and Skype calls later, I’ve ended up in Kigali, attempting to get the first pilot study underway.

YBank was founded in 2014 at the Harvard School of Public Health, by three residents at the Harvard Innovation Lab passionate about adolescent health, behavioral economics and human centered design.

Read more here: http://www.y-bank.org/#ybank

The study in Rwanda is focused around the issue of adherence to ART (anti retro-viral therapy) amongst adolescents living with HIV.

Although HIV-related mortality in general is falling, amongst adolescents HIV-related mortality actually increased by 30% between 2005 and 2013.

Previous research has shown that these  poor outcomes are being driven by lack of adherence to ART and loss to follow-up amongst adolescents compared to other age groups. Moreover, a recent study in Rwanda revealed socioeconomic factors (i.e. if you come from a family living on less than $1 a day) present the most significant barriers to adherence.

YBank are working with the University of Kigali to address this challenge using three key components:

• Incentives:

Using the power of financial savings and inclusion to motivate healthy choices.

• Peer support:

Teens helping teens through peer mentoring to stick to their medications and stay well.

• Life skills:

Provide young people with the skills to invest their savings and plan their future livelihoods.

There are several really interesting facets to this project –

Firstly, adolescent health is now widely recognized as a pressing global health issue. Teenagers will grow up to be the future parents, professionals & workforce of the future. If we don’t invest in adolescent health now, there is both a healthcare crisis and an economic disaster waiting to happen. Adolescents living with HIV are an especially pertinent example of this. Although the majority are currently healthy, poor adherence over time leads to disastrous health consequences for the individual, leading to repeated hospitalisations and the inability to work, thus creating severe economic difficulty for them, their families and society as a whole. Furthermore, the risk of onwards transmission in this population remains high – poor adherence leads to a non-suppressed viral load, and at a time when many are engaging in the high-risk behaviours (including unprotected sex) typical of adolescence in any setting, well…you can imagine the consequences.

If you want to read more about global adolescent health, the behavioural and cognitive changes that occur during adolescence, and the challenges this creates, this is an excellent article (free from the Lancet) by Prof. Susan Sawyer: http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60072-5.pdf

Secondly, the idea of cash incentives is being used more and more to promote healthy life choices – although it is a controversial issue and one which generates plenty of debate! There is some very interesting behavioral economic theory which underpins the concept – namely that by helping to promote financial inclusion (i.e. the process of opening a bank account and the idea of generating savings) and lifting an individual’s socioeconomic status, they start to value themselves and their role in society more, and hence start to make healthier life choices. Furthermore,  we know that the teenage brain is particularly sensitive to ‘rewards’, and therefore the use of even very small sums of money (for example, mobile phone credit) could be a novel and very effective motivational tool. This is an entirely new area to me, so watch this space for more information/research and thoughts on the matter as I try to catch up on all my reading!

Finally, from a development point of view, I am learning all about the new (and potentially exciting) world of ‘DIBs’ – development impact bonds. In an era in which not only is foreign aid decreasing, but the way in which we think about ‘aid’ is changing dramatically (does it do more damage than good?…probably, yes) with much more of a focus on local ownership, long-term sustainability, and impact, the way in which non-profit projects such as this one are funded will also change. Development impact bonds are similar to Social impact bonds – in very simple terms, it goes something like this:

1. Government identifies an issue (e.g. non-adherence amongst adolescents)
2. Private investors provide funds upfront (e.g. private philanthropic foundation)
3. Intermediary (e.g. NGO) implements programme to deliver an agreed outcome (e.g. 100% adolescents to have suppressed viral load in 5 years, or 95% of rural schoolchildren to have achieved basic literacy by the age of 10)
4. If the programme is successful and the agreed outcomes are delivered, the government then pays back the private investor.
5. If the outcomes are not delivered – the government does not pay anything back and the investor loses their money (although there is the potential to have a ‘guarantor’ in the equation who can pay back the investor).

It’s obviously far more complex than that, and again a concept which I am still trying to learn about and understand. But, in principle, it provides a way to transfer financial risk away from the public sector (the government) across to the private sector. It also means that the intermediary is tasked with delivering specific outcomes, and proving that the project they intend on implementing actually works. Finally, it generates the possibility of sustainability, because assuming that the project is proved to be a successful, the government can then take on responsibility for continued funding, safe in the knowledge that they are spending public money on a tried and tested program that can deliver the outcomes they need.

As yet, no DIB has been successfully implemented…so we’ll see how it goes; would welcome any advice from those with more economics knowledge than me!

Inshuti Mu Buzima

On Thursday we visited Rwinkwavu district hospital, one of the five sites across the country where the U.S. based charity ‘Partners in Health’ (and it’s local sister organisation ‘Inshuti Mu Buzima’) supports the Rwandan Ministry of Health in delivering healthcare.

Partners in Health do some amazing work in some of the poorest parts of the world. Founded by Dr. Paul Farmer, the charity’s ethos is very much focused around the ‘social determinants of health’ – not just treating patients, but also building houses, providing clean water and sanitation, education and nutrition.

Check them out: http://www.pih.org

They are also focused on supporting and sustaining existing health systems (rather than creating dependency on external support) and in building the research capacity of the institutions they work with. For example, PIH have just opened a new university in Rwanda!

I’ve just finished reading ‘Mountains beyond Mountains’ which covers the early days of the organisation working in Haiti, and tackling multi-drug resistant T.B. in the slums of Lima, as well as its often unorthodox and controversial way of operating! Well worth a read:

African Philanthropy Forum

More than just some delicious breakfast pastries (much needed thanks to the mystery cereal thief currently resident in my guesthouse), this two day conference was an incredible gathering of some of Africa’s most innovative thinkers. It was a truly enlightening and inspiring experience.

You can check out the #APF15 website here: http://philanthropyforum.org/apf/

For me, the highlights included hearing Bob Collymore (CEO of SafaricomLtd) discuss the ways in which his business has used mobile phone technology (one of the most ubiquitous possessions on the continent) to help deliver antenatal care in remote parts of Kenya, as well as to deliver food vouchers in refugee camps as part of the World Food Programme.  Similarly, Alain Nteff told us how his ‘GiftedMom’ program (an automated SMS and voice service that notifies pregnant women and mothers on when to go for their antenatal care and vaccinate their babies) is impacting over 3000 pregnant women and mothers in 18 rural communities in Cameroon – increasing the average turn out rate of antenatal care by 20%. Pretty impressive achievement by the age of 23!

There was a real focus on ‘social entrepreneurship’ – young leaders creating businesses based on values and a social mission, rather than just for profit.

As someone who has a somewhat closed-minded view of, the “big bad private sector”, it was really eye-opening to see so many passionate young business men and women mobilising economic capital for the greater good.

I particularly enjoyed the panel sessions on education, which featured two really amazing projects from South Africa (Ikamva Youth and rethink_edu). There was lots of discussion generated around young people being able to take ownership over their own learning, making the experience interactive and imaginative (moving away from simply content delivery) and focusing on competence rather than credentialism.

We also heard Rwanda’s Minister of Health Agnes Binagwaho (an incredible woman who not only serves as Minister of Health of Rwanda but is also a senior lecturer in the Department of Global Health and Social medicine at Harvard Medical School and has published over 100 peer-reviewed articles) talk about strengthening health systems. Rwanda has an incredible emphasis on community health workers and a healthcare system that is really built ‘from the bottom up’. We were even lucky enough to meet her after her speech and tell her a little about our project!

During the two days some important questions and criticisms were raised too. Should entrepreneurship be presented as a panacea? A ‘cure-all’ for a country’s economic problems? Most people don’t want to become entrepreneurs, they want jobs and relying on citizens to create their own businesses removes some of the responsibility from the government to solve the problem of youth unemployment. There were some very honest and open conversations about gender and the fact that there continues to be a culture in some communities where girls are not seen as ‘worth investing in’. Sangu Delle spoke passionately about the need for Africa to define capitalism and philanthropy on its own terms – “let the African growth story not leave behind women and the people at the bottom of the pyramid”.

Finally, we heard from HRH Sylvia Nagginda, Queen of Buganda Kingdom, Uganda. She gave a beautiful speech about the importance of leveraging culture in the process of development. She cited a speech made by Rwanda’s President, HE Paul Kagame, in which he said “we (Africa) have allowed ourselves to be defined and developed by others. What you see is what others wanted us to be. Countries that have developed and moved away [from this] have done so because they chose to define their own path”. She stated that “our culture enables us, it is our compass, to navigate the modern world. It enables us to know what is good, valuable and necessary in out world”.