It seems like yesterday but it was five months ago we began looking at the world's most impossible problems, and began meeting the people who were tackling them. We started with what seemed nearly as unattainable as world peace, the end of extreme poverty around the globe. We wrote this post about Jeffrey Sachs and the Millennium Goals, an initiative set by the UN in 2000.
Recently Liz got to talk to Karen Schmidt about the Millennium Village project in Mayange sector of Rwanda. Karen is deputy director for Access Project and Millennium Villages Rwanda, at the Center for Global Health and Economic Development (that's through the Earth Institute at Columbia University).
In 2005, Rwanda became the third of 10 sub-Saharan African countries to participate in the Millennium Villages project, meant to demonstrate that empowered communities can lift themselves out of extreme poverty within five years. The Rwandan government chose the first site, in Mayange sector, one of the poorest in the country, struggling not just with past violence but with drought and a small harvest.
Ex-pat aid workers got the program off the ground in 2006, but the projects are now run mostly by Rwandans, including a health care center that went from seeing very few patients to serving thousands. Recently, the Rwandan government announced that each of its 30 districts would implement the Millennium Villages model in their poorest sectors.
Millennium Villages is a very cool idea, one that hadn't been tried before. The keys to the model are integrated programs -- health, infrastructure, education, agriculture -- and local ownership: management of the programs is taken on by the government and by the community members who participate. "What's amazing, of course, is that for so many years, the health people would do this, and the agricultural people would do that, the education people would do this. They wouldn't work together," Karen says.
"I'm trained in public health, and we didn't learn anything about agriculture. When we started planting maize and fertilizer, I had never heard of this stuff, but it's pretty basic -- because with most childhood diseases, the reason they're so bad is because of malnutrition."
Each research village involves intense observation; up to 10 nearby villages clustered around each Millennium Village get the same interventions, but less observation. Some interventions, like the idea of planting maize in rows, have spread on their own, says Karen.
The program focuses on designing uncomplicated interventions and handing over management roles to local people. Those may seem like new ideas, but they're really no-brainers, Karen says. "The economy is not going to develop if everyone's sick," she points out. Plus, time has shown over and over again that programs have to have community buy-in if they're going to last. "That's the only way that something like this is going to continue and not just be something we did for five years," Karen says. "Ultimately, it comes down to the community, and if they don't think it's meeting their needs, then they're not going to be interested."
And interested, they are. Remember that health center that was serving almost no patients? "It wasn't because people weren't sick. It was because there was nothing there, and you had to pay for it," Karen says.
First, a medical student from Philadelphia volunteered to get the center on its feet, tracking down nurses, getting electricity and supplies flowing. He helped train a local coordinator and turned it over. Now, thousands of people come for treatment and for preventive care. "We're seeing a big drop in malaria cases, a big increase in utilization (of the center)," Karen says. "And a big increase in the number of women delivering at the health center," though some women choose to deliver at home.
Plus, the center makes family planning information available to every patient, even if they're just in for a routine vaccination for their child. "People say, you know, 'Rural people, poor people, they're not educated, they won't want to use these methods," Karen says. "We have seen that there aren't a lot of cultural barriers (to family planning). People want to be healthy."
But even more encouraging than this steady move toward progress, and the fact that 25,000 people are participating in this project after a genocide, a drought, and the impact of HIV/AIDS, is that Rwanda is now becoming a living model of what's possible.
Last year, former President Bill Clinton won a wish from TED, the social entrepreneurs, philanthropists, thought leaders, and visionaries from around the world who meet annually to incubate and nurture ideas that can change the world. (As a side note, for your 10 percent more media about possibility, TED has the full catalog of speeches by people you've heard of and people you've never heard of doing the impossible all over the globe here).
Clinton's wish was for help implementing a pilot health care program he helped start in Rwanda using Paul Farmer's successful model from Haiti and other countries Partners In Health have been working. "What we have been trying to do, working first in Rwanda ... is to develop a model for rural health care in a very poor area that can be used to deal with AIDS, TB, malaria, other infectious diseases, maternal and child health -- the whole range of health issues that people are grappling with in the developing world --that can first be scaled for the whole nation of Rwanda and then can be a model that can literally be implemented in any other poor country in the world."
Karen says, "In places where I've worked in Rwanda, most people want the same things we want. They want a safe place to live, they want to be healthy, they want their kids to be better off than they were." Now Rwandans are leading the way to achieving those simple things for more and more of their fellow citizens, showing the world what's possible, showing us ways that can work around the world to create a world fit for kids.
Speaking of kids, here's a wonderful clip from a video produced entirely by the students at the Mayange school during art classes with Karli. Yeah, making a world fit for these kids. Worth it.
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