I worked as a research intern for the Vice Chancellor, Dr.Agnes Binagwaho in the UGHE office in Kigali, Rwanda’s capital city. Each American intern was twinned with a Rwandan intern to promote a greater understanding of the place and culture in which we were working. My research was focused on cervical cancer screening techniques used in low income areas. In 2014, the Rwandan Ministry of Health piloted a program to screen women ages 35-45 for cervical cancer using an HPV DNA test. It was the largest cohort of women in Africa ever screened for cervical cancer using a DNA test. My main task was to consult with the principal investigator of the study and write a scientific paper detailing the successes and challenges of the program. HPV testing has been widely proven to be effective, cost effective, and feasible in low-income settings. HPV DNA testing is also one of the fastest growing global markets. Yet, the program in Rwanda was terminated after one year due to a lapse in funding from QIAGEN. I was also given the opportunity to author an opinion piece on the topic. Doing this work surrounded by bold thinkers at UGHE has made me realize that while there are many complicated problems, there are much more complicated excuses. Excuses are made by scholars, politicians, policy makers, and others to avoid acting on these problems. For change to occur in global health it is necessary to think big and have a sense of pragmatic optimism.
During my visit to Butaro, I had a chance to sit down and chat with the clinical director at the PIH site there. He spoke of the many challenges and hardships encountered daily by physicians and staff. While Butaro is one of the first places where low income patients can receive quality cancer treatment for free, many injustices remain palpable in access to care. I asked him how he stayed optimistic despite these obstacles. He noted that challenges will always remain, and once one problem is solved, another will emerge. It reminded me of the Haitian proverb Paul Farmer chose to open his most popular book with, beyond mountains there are mountains. Despite this, he emphasized the importance of celebrating successes and recognizing how much progress has been made. Without optimism and hope, progress is impossible.
The incredible kindness and humanity present in everyone I have met in Rwanda makes it easy for me to be optimistic about the future. Everyone in Rwanda genuinely cares; from the taxi drivers that always give a fair price, to the national park porter that held my hand for six hours during an incredibly strenuous hike. Even the eager stall owners in the chaotic kimironko market exude a genuine human spirit of entrepreneurship that is immediately recognizable. While I am ushered around to every item I didn’t know I needed, I laugh and think about how I would do the exact same thing if I were in their shoes. All of the people I have met and the incredible experiences I have had make me extremely grateful for this opportunity to live and learn in Rwanda. As my internship comes to an end, I can only hope that I will be able to return soon.