Association of Medical Doctors of ASIA, founded in 1984, Consultative Status with UN ECOSOC since 1995

There are a few unforgettable sceneries one would come across in travels: a landscape that jumps into one’s view as soon as one gets warped to an unfamiliar land; dawning skies that come as an extra reward for an early bird; a world heritage site that is far beyond one’s poor imagination. Flying over Lake Victoria, it was one such view that struck me at the very first moment when our plane entered Rwanda.

Rwanda is often cited as “a country of a thousand hills”. For those who remember Hôtel des Mille Collines from a 2004 movie “Hotel Rwanda”, “mille collines” precisely means a thousand hills. Just as what the name embodies, the landscape changes dramatically from fields to countless hills beyond Lake Victoria. Each surface of the mountain is filled with terraced fields that are lining up in an orderly manner, which reflects the wisdom of locals who try to optimize the use of limited flatlands and resources. In such regularity, I felt as if I caught a glimpse of a diligent national character of the Rwandans.

The endless terraces do not allow the horizon to appear, and what look like rice paddies and tea plantations cover the remaining areas. In fact, the very view reminded me of a Japanese scenery to which we grew up accustomed.

Our plane landed on an airport built on a summit of one of the thousand hills; needless to say that it was my first experience landing on the hilltop runway.

When asked what kind of image one has about Rwanda, what immediately comes to our mind is the 1994 genocide. However, the web search would probably show more results containing phrases such as “African Singapore”, “the top ICT nation in Africa” and “the safest and the least-corrupt African country”.

Upon arriving, I was dumbstruck by the cleanliness of the road from the airport to the city center. From the capital to rural towns, I did not see a single trash on the streets. It came to me as a big surprise to witness the same level of cleanliness our country boasts. In Rwanda, the government sets a monthly “car-free” day while avid runners pushing themselves on Sunday mornings. There is something about Rwanda that sets the nation apart from the rest.

During my 19 days in Rwanda, I was fortunate enough to visit Kigali, Miyove and Kibagabaga to conduct health checkups in primary schools and nurseries. Every place was different in terms of living environment, economic status, education and access to medical services.

As far as the actual checkup procedure was concerned, we were tasked to see children from head to toe: checking their height, weight, abdominal circumference and so forth. At the end of the checkup, kids were gathered to attend dental guidance after receiving a tooth brush.

At Umuco Mwiza, a private school in Kigali, the capital, students spoke English and even a little Japanese besides Kinyarwanda, their native tongue. Their enthusiasm and energy gave me a lot of expectations that someday a leading figure might be born out of this school. Given that we even saw kids with obesity, the students at Umuco Mwiza seemed to be relatively wealthy.

On the contrary, Miyove was totally opposite. Miyove was said to be the most impoverished area in the country, and according to Ms. Marie Louise Towari who heads Think About Education in Rwanda, the children used to lack facial expressions until her organization launched a feeding program. Now, the kids here are cheerfully playing football or having fun with play equipment. Still, they are significantly short for their age and some have less hair due to malnutrition.

Of all the places I visited this time, Kibagabaga was the place which left a tremendous impression on me. Located approximately 10-minute drive from Umuco Mwiza, Kibagabaga falls somewhere between Kigali and Miyove in terms of its economic status. However, single-parent families make up most of the households in the district where, in often cases, a mother is trying to make ends meet for the whole family as a daily laborer. In short, there didn’t seem to be much of brighter economic prospects.

“We are too poor to buy health insurance and that’s why we cannot go to the hospital.”

This is one typical response from parents when a health problem was detected in the checkup. Despite our suggestion to take their child to a clinic, it made us feel helpless whenever we got to hear such words. Among the worst cases was a 13-year-old girl who had a cervical fracture in her femur three months ago. She was enduring the pain without going to the hospital because her parents couldn’t afford the treatment. Behind the rapid economic growth lies a historical tragedy that still casts a long shadow over people’s lives.

At the end of the day, the checkup only lets people find out what their health problems are. Since providing treatment is not the purpose, “the detection of ailments” may end up as a mere data sampling for us doctors.

I felt powerless in front of patients. I strongly felt that if one were to organize a health-related effort, we have to bring with us the means and capabilities to respond to such needs.

And yet again, it is the 1994 genocide that continues to affect their society.

With Rwandan gynecologist Dr. Calliope, I also paid a courtesy visit to the Health Ministry, the Mayor of Miyove, international health-related institutions and a community church. Dr. Calliope has been working on institutionalizing the school health checkup along with initiatives related to maternal and infant care.

If one were to bring about a change in a country that doesn’t have enough medical capacity or public health measures, I learned that it is important to cooperate with likeminded others and to not fight alone.

Seeing my senior doctors on the team, the program provided me with a valuable lesson: “Without capabilities, nothing can be achieved just by passion.” In addition, our effort could result in one-sided assistance without having to learn the historical background of the country and its people.
 

My week-long participation in the program gave me the opportunity to see the doctors who are committed to medical activities in the developing world. It really helped me narrow down the focus of my future career.

Although I still have a lot to learn, as a pediatrician, I hope to hone my skills in Japan and acquire what it takes to be a competent doctor in Rwanda.