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My Personal Take on Rwanda: 2018 School Health Checkup Program in Rwanda

Publication date:2019-01-22
 
*This article is a report from Dr. Kenji Urayama who participated in "2018 School Health Checkup Program in Rwanda" which was held in September 2018.

By Dr. Kenji Urayama
(Pediatrician, Okayama Medical Center)
Introduction:

Despite my years of longing for the so-called “international cooperation” or “international exchange”, I never felt the urge to commit myself to such deeds unless I was completely confident with my own capabilities.

In a sense, for a pediatrician who had long contemplated over my joining the program, the offer I received at this time was a dream come true. Since some of my colleagues at Okayama Medical Center had joined this mission in the last two years, I immediately decided to partake in it.

After coming back from Rwanda, I felt fortunate enough to have been able to get a glimpse of Rwandan children and their daily life. My overall impression was that, except for those who were sick, the kids were extremely cheerful.

Before leaving Japan, I was slightly baffled by the necessary arrangements I had to make at my workplace. But the preparation truly made my trip worthwhile after all.

Miyove:

Miyove in the north is located three-hour drive from Kigali, the capital of Rwanda. After driving through the bumpy mountainous roads, the energetic singing of children welcomed us at what is known to be the school in the most impoverished village. Their voices soothed me with the fresh breeze that swept through the 1,800-meter altitude.

The kids responded in a loud voice as their teachers called out. While being moved by their innocence, I thought this could be one trait that triggered the genocide, a negative history of this nation. Perhaps, the people here are too pure.

Contrary to their vigor, there seemed to be a number of children with decayed teeth and bloated stomach. Some of the worst cases showed that their teeth were largely hollowed out, so much so that the children no longer felt any pain. As for the bloated stomach, it was most likely caused by malnutrition or parasitic infection and never was obesity. However, what began to dawn on me was the fact that they were doing fine in spite of such ailments. There were certain symptoms to be treated, but it was difficult to determine how much medical intervention had to be made.

 
                Singing children                             A health checkup in Miyove

Umuco Mwiza:

On the following day, we visited Umuco Mwiza, a school founded by Ms. Marie Louise Towari who heads “Think About Education in Rwanda” (TER), an NPO dedicated to uplifting education in the nation. The students at Umuco Mwiza were relatively well off compared to students from other schools, which was also visible in their health conditions. Instead of tooth decay or ascites, we even saw children who were overweight.

The children at Umuco Mwiza seemed somewhat reserved compared to Miyove’s. Although they maintained the same level of energy, one might say the kids at Umuco Mwiza could be “urban” to some extent. When I saw a group of children dancing to drum beats in the school yard, I came to love it for the African-ness it evoked. Among the group was a girl dancing rhythmically with a neat hairdo: the kind you seldom come across in Miyove. An encounter with a girl like this itself depicted the obvious regional gap.

 
                The stylish hairdo                                 Dancing children

For an icebreaker and to assess their language development, I asked the children their name and age in English at the beginning of the health checkup. English was introduced as one of the official languages in Rwanda in 2009 and what I saw this time was the very outcome of it.

At Umuco Mwiza, a lot of children were capable of responding in English regardless of their age. In Miyove, only a half of them could answer their name; the number got fewer as they were asked to tell their age. In Kibagabaga, the figures were 90 percent/30 percent for each question.
 
In Japan, the use of English has always stirred the education sector. Seeing this, I couldn’t help thinking what really works in reality. (On a side note, my nine-year-old son, whose school curriculum already included English, could answer his name but not his age.)

Kibagabaga:

Two days later, we moved to Kibagabaga Primary School in the same city. Unlike other schools that were basically made with bricks, Kibagabaga had a prefabricated building with a tinned roof. The building lacked the ceiling board which made it noisy in the rain.

I used to see a national flag of China painted on the school wall in Miyove. It surprised me that the Chinese were already venturing into the part of the city where foreigners rarely entered. In Kibagabaga, however, I did not witness any Chinese influence over the area.

I saw a certain number of children with ailments (e.g. undescended testicles or dactylosymphysis) that are usually treated before they reach school age in Japan. There were also children with goiter or low height.

If I were to categorize the kids from Kibagabaga, they would fall somewhere between Miyove and Umuco Mwiza. The kids were almost as cheerful as the Miyobe kids, but there was a subtle sense of melancholy that surrounded them. In Kibagabaga, the difference in the living standard of each student seemed much more distinct. Their clothing, for instance, clearly showed their economic status.

On the other hand, handmade scientific posters posted to the classroom wall were enough to display their passion for education. One thing that struck me was a Japanese news bulletin which featured articles pertaining to Hiroshima A-bomb. I learned that the bulletin was made and sent by primary school students in Japan, and this definitely showed the unique learning system of this school.

 
            The posters on the wall                     News bulletin sent from Japan

In Kibagabaga, there was a watering place which was located just below the school building on the slope. Water trickled through the hole and even the neighbors were using it on a daily basis.

Right above the slope was a school toilet (from which night soil may be collected). It was a few meters away from the school building. Its flush tank was almost empty and it was by no means assuring the sanitary condition of the place. The school also had a well, but the villagers would go to low lands for most of their water supply.

Including the guesthouse where we stayed, most of the buildings in the city area were equipped with water tanks to preserve rain water or water from the national water supplier. While knowing that securing clean water in Rwanda is not an easy task, I firmly believe it holds the key to improving children’s health conditions.
 

Conclusion:

Be it the health checkup for elementary schoolers, preschoolers or 18-month-olds, it is needless to say that any form of health examination contributes to children’s wellbeing. However, what is required for its systematic implementation in Rwanda is not just about educating service providers. One must understand that it is the receiving end that needs to recognize the benefit of it.

It is fair to say that foreign doctors seeing a total of 950 children was a huge success. On the contrary, one should doubt that the feasibility of the project in the long run. Sooner or later, it will lose the allure to mobilize the manpower if it were to keep relying on foreign aid. By carefully taking this into account, my ideal scenario would be to establish a system that allows itself to run sustainably and comprehensively.

In closing, I would like to thank AMDA, TER, the Embassy of Japan in Rwanda, Nagasaki University, and everyone at the schools and facilities we visited for their kind support. Without your earnest assistance, our project could not have been more successful. Thank you so much once again for making it a precious one.

    •  Primary Health Care & Promotion of Health Awareness (Promotion of Health)
    •  Rwanda
    •  2018
    •  GPSP

 
 
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