June 26, 2019
By Janice Biehn
For Antoinette (Toni) Habinshuti, making health care accessible to her fellow Rwandans is merely a matter of equal opportunity. Over the course of a week-long visit to the Diocese of Toronto, she shares the story of Vestine, a woman living in rural northern Rwanda, and compares it to her own. “It’s a pretty simple equation. Toni + opportunity = healthy baby; Vestine – opportunity = unhealthy baby.”
Habinshuti is the Deputy Executive Director of Partners in Health Rwanda, working in three districts of Rwanda to bring quality health care to “the middle of nowhere.” PIH Rwanda is the local implementing partner of The Primate’s World Relief and Development Fund’s All Mothers and Children Count program, funded by PWRDF and matched by the Government of Canada 6:1. Vestine, like Habinshuti, had a premature baby, so Habinshuti’s comparison is poignant. She tells the story of Vestine to illustrate the continuum of care that is vital to delivering healthy babies, and then the follow-up care that ensures they become healthy children.
Vestine’s story begins in Burera district in the hills of northern Rwanda, in a remote community of Nyamicucu that is a nine-hour walk from the nearest hospital. Vestine wasn’t feeling well so spoke to her neighbour, who is a community health worker in her village. The CHW convinced Vestine to have a check-up. Vestine thought there was no way she could be pregnant, but tests proved otherwise, and thanks to this early intervention Vestine could confirm her HIV status and take any precautions required to prevent mother-child transmission.
Already these points of contact provide opportunities to talk about family planning and child spacing, says Habinshuti. “That’s the best time, not right after you’ve had a baby,” she says. Vestine’s pregnancy was routine until in the seventh month when she went into premature labour. The district ambulance, courtesy of PIH Rwanda, was called into service to take Vestine to the nearby health center, where maternity services has been added. Then more complications arose and Vestine was carted back into the ambulance to go to the Government of Rwanda’s state-of-the-art Butaro hospital for an emergency C-section.
Baby and Vestine are both doing well, thanks to all the interventions along the way. “But it was not just one intervention,” says Habinshuti. “It was several. The CHW, the prenatal visits, the fact the ambulance was in the village, the adequate health center, the modern hospital, they were all crucial.” She added, “This illustrates that no single intervention, no matter how effective, can by itself prevent the unnecessary maternal and child death occurring in rural Africa everyday: high quality maternal and child health services means getting all these steps right; if the health systems did four things well but just missed one step, Vestine and her child might have not survived. Continuum of care and integration of services allow us to get all things right and save Vestine and the thousands of other Rwandan mothers.”
Habinshuti described in her presentations how follow-up social supports are also extremely important. “We put all the work into making sure that baby comes into the world healthy, now what are the chances that if Vestine can’t feed herself that her baby will thrive?” Through AMCC, PIH Rwanda distributes livestock like goats and ducks to women. The animals’ milk and eggs provide an important nutritional boost, but they also provide manure, which is the first step to cultivating a productive garden. “Families no longer measure their crop yields in kilograms,” says Habinshuti, “but in tonnes.”
Habinshuti was a guest speaker at St. Olave’s, Swansea in York-Credit Valley, spoke at a Lunch and Learn at St. George’s Allandale in Barrie in York-Simcoe, visited diocesan staff and diocesan ACW executive in downtown Toronto, presented a webinar from PWRDF’s office and spoke at St. Peter’s, Erindale in York-Credit Valley. At many of these events, she screened a video about a woman named Safina. In it, Safina, a Muslim, describes how she sends her husband to the market to sell the super-sized banana plants from her banana grove. “There is an unwritten truth in this story,” says Habinshuti. “Safina is the one who sends her husband to market, who buys the health insurance for her family, who provides for her family. That is empowerment.”
At her presentations, Habinshuti also placed PIH Rwanda’s work in the context of rebuilding the country after the genocide against the Tutsi that tore it apart 25 years ago. Almost a million people died in 100 days, including some of Habinshuti’s extended family (she was living in the Democratic Republic of the Congo at the time). In 2005, Partners in Health, a Boston-based charity, was invited by the Rwandan government to help it provide services in Burera, Kayonza, and Kirehe districts. There are three hospitals, 42 health centres, and a network of more than 6,000 community health workers like Vestine’s who make it their business to get into hard to reach places and serve people.
The results speak for themselves. In 2015, only one in five women ages 15-49 said they needed family planning services, nine out of 10 women delivered their babies in health facilities, and almost half attended all four recommended antenatal care visits. However, 38% of children under five were characterized as being stunted, which means future health problems. Food security is improving but is still an issue, with only 43% of households in 2018 being food secure, and 30% getting their food from what they produce. Perhaps most impressive, Rwanda’s life expectancy has more than doubled since the genocide, from 29 to 69.
Habinshuti was visiting Toronto after spending a week in Vancouver presenting on PWRDF’s behalf at Women Deliver, an international conference dedicated to improving and advocating for the health and rights of girls and women. Shortly after her return to Rwanda, Habinshuti was named as one five global health pioneers to Harvard University’s inaugural Women Leaders in Global Health LEAD fellowship (Learn, Engage, Advance, Disrupt).