Since returning from my travels in July, I have been volunteering three mornings/week at the Bugesera District Hospital and Health Centers through The Access Project, an organization affiliated with Columbia University whose mission is to improve the management and infrastructure of health centers in Rwanda and other developing countries. One of the projects I have been assisting is the opening of a health center located in the village of Gashora, which is to serve as a model for the 11 existing health centers in Bugesera. Most of the work necessary for opening this health center has been or will be carried out by the district health advisor, Rwandan Ministry of Health and district officials as well as other Access personnel, but one of my responsibilities in this project has been to liaise with leadership at the district health center as well as health-centered NGOs operating in Bugesera to assess the district’s needs with respect to nutrition. The Gashora Health Center and Access will then use this information to create a first-rate nutrition treatment program at this health center and improve the existing programs within Bugesera. It may come as no surprise that malnutrition in Rwanda is dire. According to the World Food Programme, one third of Rwanda’s total population suffers from malnutrition. The situation is even worse among children, over 40% of whom suffer from chronic malnutrition and 56% of whom are anemic. The country’s global hunger index, which combines data on child malnutrition, child mortality and caloric deficiency, is categorized as alarming. Sometimes I joke about how horrible the food is in this country, but in a way it makes sense when you consider how many people eat what is available, often 1 meal/day, for the sole purpose of survival. Among most households in Rwanda – 28% of which are food insecure - spending more time than necessary in preparing one of the few staple foods available in this country (rice, beans and starchy banana) with a special spice or flavor is uncommon due to lack of time and resources. And in this most densely populated country in Africa, ninety percent of the population relies on subsistence farming for survival.
What can be done to combat malnutrition? At the most basic level, it is important that community health centers and health workers identify and target at-risk populations for education, prevention and intervention when necessary. Pregnant women and young children are especially vulnerable to malnutrition due to their needs for additional energy and nutrients in order to maintain healthy growth. People who are HIV+ are also at a special risk, since malnutrition will weaken the immune system and worsen the symptoms of the virus. Throughout Rwanda, community health centers like those in Bugesera are strongly encouraged by the Ministry of Health to run regular kitchen garden demonstrations for local residents. In these demonstrations, the nutritionist and community health workers show how to best use and maintain even a small plot of land, how/why to cultivate vegetables like carrots, tomatoes and green beans, rich in vitamins and nutrients that are essential to healthy cell growth, and where to go for help when a family member or neighbor is suffering from malnutrition. In addition to providing food aid, agencies such as the UN World Food Programme, World Health Organization and Gardens for Health support projects that connect rural farmers to markets within Rwanda and abroad. And organizations like Project Healthy Children contribute to ending malnutrition by advocating governments to mandate that foods, even those produced locally, be fortified with nutrients such as Vitamin A, iron, zinc. Other nutrition and child health agencies that operate in Bugesera include The Elizabeth Glaser Pediatric AIDS Foundation, The Imbuto Foundation and The Global Fund. Links to each of these organizations are posted on the right.
Above photo source: Médecins Sans Frontières, www.msf.org.ukReferences: Health Indicators, Republic of Rwanda Minsitry of Health. http://www.moh.gov.rw/index.php?option=com_content&view=category&layout=blog&id=27&Itemid=27
Rwanda, World Food Programme. http://www.wfp.org/countries/rwanda
Malnutrition and Rwanda, Gardens for Health. http://www.gardensforhealth.org/malnutrition.php#footnote
Anyango, Gloria. “Rwanda: Kitchen Gardens Eradicate Malnutrition.” The New Times (via All Africa.com), 30 September 2009. http://allafrica.com/stories/200809300068.html
“Rwandan Children Suffering from Malnutrition, Claims Health Official.” VSO News, 22 May 2009. http://www.vso.org.uk/news/19182659/rwandan-children-suffering-from-malnutrition-claims-health-official
