Brookline High School February 2006 Inshuti Mu Buzima

Mission PIH began working in Rwanda in April 2005 by invitation of the Ministry of Health and working in partnership with the Clinton Foundation and Global Fund to Fight, AIDS, Tuberculosis and Malaria. To work in collaboration with the Ministry of Health on achieving the community based scale up of comprehensive HIV care and treatment in two rural districts in Rwanda which are supported by the Global Fund. To assist the Ministry of Health in the development of a model based on these two sites that can be expanded to other sites in the country. To assist at TRAC at the national level in the training of health professionals, development of guidelines and evaluation of HIV care and treatment project. To work with the Clinton Foundation HIV/AIDS Initiative (CHAI) to export this model to other African countries.

Achievements Patient Care  PIH “Four Pillar” model (HIV, TB, STI, women’s health) brought to 4 sites, Rwinkwavu, Kirehe, Mulindi and Rukira. In addition, nurses at Rusumo and Nyarubuye hired and trained.  The flagship hospital at Rwinkwavu sees an average of 160 patients per day: 70 primary care, 50 infectious disease, and 40 women's health clinic.  At all sites, 31,040 VCT administered, 2,452 HIV+, 3,504 CD4.  700+ patients are on ARVs, including 80 children.  200+ patients on TB meds (about 100 of these patients are also on ARVs).  400 mothers (and their infants) are in the PTME/formula program. Staffing By the end of 2005, PIH directly employed 51 Rwandan staff, jointly hired 176 with the GFATM/MOH, and built a network of 500 accompagnateurs. Program on Social and Economic Rights (POSER)  Food: Nutritional support to all HIV, TB patients and a few social support cases. In December, 751 patients received food.  Housing: First house for an HIV patient and family completed.  Education: Launched school fee program for HIV+ children or children of HIV+ patients. Supported 160 secondary school children and working with primary schools for several hundred.

Rwanda Facts Population: 8,440,820 Rwanda is a poor rural country with about 90% of the population engaged in (mainly subsistence) agriculture. It is the most densely populated country in Africa and is landlocked with few natural resources and minimal industry. During 100 days of genocide in April 1994, more than 800,000 Rwandans were killed. Children lost parents and relatives, entire families were wiped out. By the end of the genocide, hundreds of thousands of children had been orphaned. With a widening HIV/AIDS epidemic and continuing outbreaks of malaria, a total of 613,000 orphans were living in Rwanda by the year 2001, this translates to 18 percent of all children ages 0–14.. Over 43% of these children have been orphaned by AIDS.

While the HIV -5.1%- is much lower than the average of Eastern and Southern Africa. It's estimated there's some 420,000 Rwandans who are HIV positive More then 400,000 children are out of school Rwanda has one of the world’s worst child mortality rates – 1 in 5 Rwandan children dies before his or her fifth birthday Over 100,000 children living in child headed households Rwanda has one of the world's largest proportions of child- headed households, with an estimated 101,000 children living in 42,000 such households.

Major Challenges for 2006 Implement full four pillar model at six sites Reinforce community based care Prioritize social assistance components of the model Strengthen research and training elements of the work Share best practices within PIH sites Export the model to other Rwandan and African sites Reach and maintain high standard of care and professionalism

Report on HIV patient enrollment generated by IMB staff from EMR data

Case Study: Claudine Humure Claudine is a 14 year old orphan from Rwanda. She suffers from Osteosarcoma, a rare form of bone cancer. Claudine is almost finished her chemotherapy which she is undergoing at Mass General Hospital. She has been staying with a family in South Boston. Why her? With the severity of her illness and her chances of living, had she stayed in Rwanda, Claudine was a good candidate for coming to the U.S. for treatment. Claudine hopes to become a doctor to help people like her get well.

Things you can do to help… Give Time: Volunteer with health-related groups, host an educational event, or engage others in a hands-on activity. Speak Out: Let your friends, neighbors, and government policymakers know what you think. Write a letter or send them an . Donate: One of the easiest, most effective ways you can make a difference at the global level is to help a child get appropriate health interventions. You can do this by donating money to aid organizations involved in global or children’s health. “One drop of water in the ocean makes it that much fuller.” –Author unknown