Fieldnotes: Blogging on UNICEF's child survival work in the field

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Our last visit was to the Murama 'Catch Up' program that is located in the primary school in the Bugesera District about 40km east of Kigali. The goal is to provide a basic education to all children even though they may have missed a grade or two. The program began in 2005 and is currently at an enrollment of 179 children - 112 boys and 67 girls. They are distributed into levels that lead them to prepare for the leaving exam so they advance to the mainstream school system. The rest of the children have classes as usual. The Ministry of Education developed a curriculum for this program that includes language, math, science and technology, and social sciences - including HIV/AIDS and peace education. Eventually, they aim to have at least 1 catch up school in each district of the country, for a total of 30.

© U.S. Fund for UNICEF/Rusanganwa

UNICEF is assisting these schools as they focus the programming on human rights. Capacity building empowers the communities to reach a self-sustaining level and grants them ownership of their own progress. Two agricultural cooperatives were created to add to their success. A school garden and animal husbandry system have been integrated into the program which is managed by the parents. (Again, parents are involved in the food program by preparing porridge for breakfast and a lunch as well.) Pigs are housed behind the schools and they are sold and also used in the school feeding program. Proceeds from the sales are distributed among families who participate and help. The fertilizer that the pigs produce is used in the gardens of beans, corn, pineapple to name a few.

The involvement of the parents is increasing annually and is helping tremendously and I have mentioned it several times through this blog. The elements that contribute to this concept include involving parents in the school's programs, creating what we call a child friendly school, was a pilot project for the Murama school. Their success is spreading throughout the country.

The concept of child friendly includes implementing psychosocial support through activities such as sports and peer clubs. Water tanks that provide clean running water were also installed and included teaching children about sanitation. Latrines are separate, when they were previously together. All of these components make the schools more amenable for children to attend school and the girls are more likely to stay when they are more friendly to them as well.

The grand conclusion was an incredible celebration presented by some of the children in the school. They danced traditional dances outside under a tree. The rain came and suddenly we were rushed into a small classroom where two groups of girls danced for us and had us join them. Their graceful rhythm entertained us with great interest and we learned about the symbolic movements and stories they told with their motions.

© U.S. Fund for UNICEF/Rusanganwa

© U.S. Fund for UNICEF/Rusanganwa

This country is beautiful, as are the Rwandans, and we have been incredibly fortunate to have the opportunity to meet every single person we encountered on this trip. From the travellers from the States, to the UNICEF staff who led us through the projects, to the drivers who took us all over the country, to our traveling photographer, Laurent, whose pictures will be downloaded soon, and to the wonderful people leading the projects on the ground who should be extremely proud of the success they are achieving. I would like to take this opportunity to thank each and every one of you who made our trip so pleasant. We appreciate it immensely and we are thinking of you always and wishing you continued tremendous success!

All the best from all of us, Linda

The last part of our trip focused on education. We first visited the Rubingo primary school located in the Gasabo district outside of Kigali. The ride to the school was surreal as a storm was coming, forcing the clouds to shift to the top of the hill where the school is located. Fog blurred our view of the community but we were able to get a good idea of the character once we arrived at the school.

© U.S. Fund for UNICEF/Rusanganwa

Located in a rural community, this UNICEF-built school has over 1,220 children enrolled - almost equal with boys and girls. One of 50 similar schools country-wide, there are only 18 teachers which results in a large student to teacher ratio. The goal is to reach 1:55, teacher to students, which is still difficult to manage but there is a lot of outside help.

The Parents' Association has been volunteering in the food, nutrition and recreation programs and teachers are being trained by some partner NGOs, creating a model child-friendly environment. The curriculum is set at the National level but an additional component is added to these schools, of which there are 20 schools participating. A mentorship program aides students to consider a path to take once they finish school. This project is too new to have measurable results but it is another indicator of hope and planning for a successful future.

© U.S. Fund for UNICEF/Rusanganwa

Finally, the school is also adding psychosocial support to those who are in need - orphans, former street children, and those who have experienced trauma. Peer clubs - soccer, singing, anti-AIDS, to name a few - are helping the kids to process their feelings and work through them. Managing pain and anger effectively is leading them towards an end goal of strength and reconciliation. This is a goal for all throughout the country. The difference with this school model is that they're starting early.

© U.S. Fund for UNICEF/Rusanganwa

It is a beautiful school with a dedicated team of educators who will be sure to lead the students to success. I should note that there were some students who came to school just to meet us to sing for us. Their beautiful voices were a warm welcome for us and it was flattering that they would come to school during the break to meet us. That's a pretty good indication of the motivation level!

Sifting though the archives we came across some old Trick-or-Treat for UNICEF boxes. Many of us here have fond memories of carrying one of these little orange boxes on Halloween. They've inspired a bit of internal debate about which is on is "the best" Trick-or-Treat for UNICEF box.

Can you help us decide?

Vote for your favorite Trick-or-Treat for UNICEF Box today. And feel free to use the comments to share your fondest memories and stories of Halloweens past.

What an honor was to have the Mayor of Nyanza give us a warm greeting after we entered his District. He was proud to show us the different programs that are underway under his watch as UNICEF is one of only a few partners to support the work conducted in this District. We were extremely flattered to have the opportunity to meet him.

The district is mostly rural with a population of about 250,000. Their first priority is to give hope and aid to the recovery of the people in the District. A new judicial system has been implemented in 2005 which is bringing people to trial who have committed human rights crimes during the genocide. Their second priority is to focus attention on the occurrance of HIV in the area and reduce infant mortality.

"One cow, one family" encourages more agriculture to the community by granting each family a cow. More milk for the family and more fertilizer - a "gift" from the cow - will be beneficial to the progress of better agricultural practices. Eventually the cows are eaten but more of these families consume goat for their protein. Finally, about 60% of the population receives clean water which comes from the local springs. Nutrition education, hygiene, and malaria reduction are also given great attention.

© U.S. Fund for UNICEF/Rusanganwa

There are about 100,000 children in the District and 42% of them are under 18. The goal is to have every child reach grade 6 but, as can be expected, it would be preferable for them to reach grade 11.

We first went to Busoro where people get tested for HIV. Approximately 80% of the women are now coming with their husbands which is a huge advancement from what had been happening in the past. Antenatal care, HIV testing and results are all conducted in one day so when people have to walk for hours to get to the clinic, this kind of attention makes it more attractive for patients to get tested. An antiretroviral program was initiated by UNICEF to treat HIV+ patients as well as a grant to provide funding for health insurance which costs each person 1,000 francs per person per year. This equals less than $2 for a year of health insurance!

© U.S. Fund for UNICEF/Rusanganwa

We then went to the community weigh-in clinic which took place under a tree in the neighborhood. Malnutrition is a big problem in the rural areas as it has increased from 4% to 7.5% since 1994. With the implementation of a community health care worker program in the area, locals are trained to teach mothers proper nutrition for the infants. Even though they are poor, they are getting more of what they need nutritionally. Before each session, the women are counseled on better feeding habits leading to improved nutrition. These sessions take place one time per month and they rate the child's growth, based on a monitoring growth chart, is tracked on a health card. UNICEF has provided the scales, the growth charts, health cards, as well as the training over 1,000 mentors who now conduct growth monitoring for children under 5 years old in 362 communities.

© U.S. Fund for UNICEF/Rusanganwa

To supplement the nutrition program, a women's cooperative has been created that provides food for the community. There are 39 of these coops in the District of Nyanza (population 250,000) and 9 of them are in Busoro. In each group there are about 25 women who manage the lots of land granted by the government where they grow food for themselves and then sell the rest. The goal is to enable them to pay for their own health insurance and buy their own mosquito nets. This program has reduced malnutrition from 7% to 2% in about 2 years. While other problems still exist, such as malaria, there is significant progress in the health of this community.

© U.S. Fund for UNICEF/Rusanganwa

It does, indeed, take a village.

Thanks for your comments everyone!
Jenn - I will write about the most impactful moment below but I must say what is most striking is the beauty of the people, their country, and the hope they have for improved lives.
Tracy - There is really no division between what were two divisive groups. This is one country with one people and since 1994, they are moving forward with the power of forgiveness. The rest of the world can learn from their strength.

There are few words that can accurately describe the people that we have met on this trip. Further, I find it challenging to summarize the emotional impact they have had on me. To begin, we went to the TRAC Clinic - Treatment and Research AIDS Center - which provides health services to the public and private sectors. They established a highly successful outreach program for pre-testing counseling, HIV testing and post-testing counseling. Treatment for HIV+ patients are followed with great attention as they are required to return to the clinic every 6 months and if they don't come for their regularly scheduled appointment, they are visited by a home health care worker for follow up.

What is astonishing about their counseling program is the manner in which they describe the HIV virus to patients. A series of cartoons depicts the role of the red blood cell, the white blood cell, antibodies and how the virus weakens the body. Such an educational tool should be used globally so that viruses can be better understood by patients, especially those who have not had an opportunity to learn it in school.

But the more incredible component of this visit was meeting three children who are HIV+ since birth. Each had the courage to stand in front of our group to talk about how they learned of their status and how the clinic has helped them. Two of them were girls, both age 12, and the boy was 13 and all spoke with soft melodic voices. When asked about their aspirations, the boy said he wanted to be in the Ministry of Government and one of the girls said she wanted to be President! Once again the element of hope became crystal clear. These children were so courageous to speak to us about such a stigmatized illness and I will never forget them.

Rwinkwavu Hospital was next located in the Kayonza District in the eastern part of the country close to Tanzania. Initiated in 2005 by Partners in Health, this health facility is funded in partnership by UNICEF and the Clinton Foundation. This is an expansive hospital, managed by an energetic top notch pediatrician, serves as a model for other hospitals around the country to address the pandemics of poverty and disease. Pediatric HIV/AIDS and prevention of mother to child transmission (PMTCT) of HIV are the 2 main focal points to address child survival programs and reach the outer community. Due to the rural location of the hospital, this work is complemented by a community health care worker program that gives the hospital additional eyes and ears on the needs of the community while giving them care at the same time. (n.b. I have mentioned community health care previously and we have witnessed several successful integrations of having such a system in these rural areas. It amplifies the reach of health care where some would not otherwise have contact with quality care nor important nutritional information.) The community health care workers are trained by the hospital which empowers the members of the community to participate. In addition, medical care is well received when delivered by trusted peers. The power of trust can go a long way.

Tomorrow we head to the Nyanza District in the southern province to see a community based nutrition program in Busoro. Until next time...

What a spectacular country!! It is truly beautiful here with cool temperatures and sunshine.

We began the day with a briefing at the UNICEF office and had the pleasure of meeting a handful of the 60 staff who work at this country office. Being the only UNICEF office in the country, they have a lot of territory to cover. With a goal of reaching the middle income level by the year 2020, this staff is both steadfast and inspiring. As we travel around the country, it is clear to see that this hope is embraced by the rest of the population as people are hard at work - in the fields, in health and education, as well as tourism and commerce, to name a few. And the success rates demonstrate the results of their hard work - malaria has been reduced considerably due to increased use of bednets in addition to a new drug that treats the illness. In addition, a reduction in HIV/AIDS cases has shown incredible improvement based on the buy-in from the government leading to increased outreach and education.

One of the most interesting projects to me was the Children's Summit. This project is aimed to encourage children to speak out about their views of the current state of the country, as they see their daily lives, and share their hopes for the future with their classmates. Initiated in 2004, children in each district, age 10-16, were selected to discuss questions that related to post-genocide issues. The children were narrowed to a smaller group and their conversations were taken to the national level, with an added group of the most vulnerable children of the country. In total, a group of 250 youth spoke at the summit that was televised country-wide to let the country know how kids felt and what they needed for their future. Now an annual event, this summit empowers the teens with leadership skills and ownership of making a change for themselves.

© U.S. Fund for UNICEF/Rusanganwa

© U.S. Fund for UNICEF/Rusanganwa

We then went to FIDESCO, a local non-governmental organization north of Kigali which is aimed at taking kids off the streets. With the goal of integrating the kids back into their families and communities of origin, this "drop in center" protects the kids from violence and abuse. They are also provided with food, shelter, health services and vocational training. We went to another site where the kids were practicing the skills they learned from a mechanics class. Successful stories from the program include one young man who is now a mentor to the boys and another who has his own business as a mechanic and supports his siblings.

© U.S. Fund for UNICEF/Rusanganwa

© U.S. Fund for UNICEF/Rusanganwa

Kabuga Youth Center was next. Reinitiated by the Rwandan First Lady Office, the center provides a space for young people to learn about HIV/AIDS and reproductive health in a confidential environment as well as to engage them in support programs and recreational activities. Clubs at the center, such as singing, dancing, and soccer, provide both recreation as well as support for the kids. The group we met was the second of girls, ages 16-20. When asked what they liked most about the center, one replied "I believe the most important thing is to learn how to sustain ourselves." Another replied, "I like being social." With positive attitudes like these, complemented by a tremendous success rate in outreach - 400 teens are getting tested for HIV per month, demonstrating a reduction in cases from 7.6% down to 3.4% - the youth of Rwanda have many hopes and dreams they plan to fulfill. And they aren't giving up anytime soon.

© U.S. Fund for UNICEF/Rusanganwa

© U.S. Fund for UNICEF/Rusanganwa

Until next time. Bon soir!

© U.S. Fund for UNICEF/Naugle

After a warm welcome from Rita and Flavia, our UNICEF-Rwanda colleagues, we were driven into the hills of Kigali to Hotel des Millle Collines. Known to many in the world as Hotel Rwanda, we knew our quarters for the week were going to have as much to say about the country and its culture as our UNICEF hosts.

	© U.S. Fund for UNICEF/Naugle

A good night's rest prepared us for a Sunday morning visit to the Kigali Memorial Center. In order to fully capture how UNICEF continues its aid to Rwanda, we opted to visit the Center which focuses on the Rwandan genocide - before, during and after - as well as genocides in other countries such as Germany, Poland, Bosnia and Cambodia. Outside lay the graves of over 250,000 people who had died and more are still being created as remains continue to be found. We lay floral wreaths as we pay our respects.

© U.S. Fund for UNICEF/Naugle

We then toured the city and learned that each of the thousand hills has a name - Gisozi, Remera, Kibagabaga, to name a few. As we drove through these hills, we passed fields of tomato, broccoli, cabbage, corn, avacado, papaya, beans and peas. Much of the business in Rwanda is subsistence farming while some crops are exported such as coffee and tea. Bananas are also produced here with a whopping 70 percent going towards the production of banana beer, a wine-like beverage we have yet to taste. They also harvest cattle, goat, sheep and cow for meat and milk products while they import sugar and rice. The land is very arable with sufficient rainfall but land is best near the volcanic regions. Potatoes are the cash crop in those areas.

Since the time of the genocide, the country has been healing both economically and emotionally. Trials continue to punish those who confess or are turned in for performing unforgivable acts of violence 13 years ago. Dr. Jane Muita, UNICEF's HIV/AIDS specialist, tells us that there are many indicators measuring success in the healing process in a culture that is embracing forgiveness. Among them include school advancement and an increase in marriages. These successes demonstrate hope and a vision for the future. But the most important measure, she notes, is that this country of beautiful people is full of smiles. That is an indicator that cannot be challenged.

We look forward to an overview of UNICEF in Rwanda tomorrow as well as some visits to some health care sites. Please come back and visit again!

Hello, my name is Linda Naugle and I work for the U.S. Fund for UNICEF in New York. For the next week, I will be traveling in Rwanda with UNICEF supporters, visiting our program sites and meeting the people of Rwanda while learning more about UNICEF's incredible successes in this country.

Rwanda, known as the Land of a Thousand Hills, is still recovering from a violent and tumultuous past that feels all too recent. But the genocide of 1994 has changed components of the social structure, including more women taking on leadership roles. They have been prominent in and outside the government, and were elected to fill nearly half the seats in the lower house of Parliament. Their leadership has been critical to the continuing recovery of a nation that lost one-tenth of its population in about 100 days, according to international peace experts. Interacting with these courageous women will be incredibly inspiring, to be sure.

I will arrive in Kigali, the capital of Rwanda, at night on October 20 and will meet my six fellow travelers then. We will begin our journey the next day with an overview of UNICEF in Rwanda led by the local field staff. Please come back to visit this site and join us on our journey.

UNICEF runs vaccination campaigns around the world. We've been reporting on some of them recently -- in Afghanistan, in Indonesia... The campaigns are tailored to the locations, but one thing always seems to be the same: kids don't enjoy them. Here's three-month-old Vishal, crying as he's vaccinated against polio, at a community health center in India's Rajasthan State.

© UNICEF/HQ05-2387/Anita Khemka

Forty percent of the world's children receive immunizations through UNICEF's leadership. That's a lot of tears, but also a lot of young lives saved.

Jenna Bush, daughter of President George W. Bush and Mrs. Laura Bush, interned with UNICEF in Latin America and the Caribbean from September 2006 through May 2007. Based on her experience, she wrote Ana's Story, a personal, narrative nonfiction account of a girl who struggles to break free from a vicious cycle of abuse, poverty and illness.

We're selling a signed-first edition of Jenna's book on eBay. The auction ends on Monday. Please consider bidding on the signed book by clicking the banner below. Or, buy the book from ShopUNICEF.