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August 31, 2007
What, exactly, is Caitlin doing in Rwanda?
(August 3rd) I have been delinquent about updating this blog. This is mostly because I have been busy, but it is partially because I have had a hard time coming up with something to say, not for lack of material, but for lack of insight. There is no sense to be made in Rwanda, and few conclusions to draw.
I have noticed, however, that I have been negligent in explaining what I am doing here, and what my internship involves. I work for WE-ACT, a group that does HIV-related care for women who are positive as a result of rape during the genocide. They also have a family program, income generation, peer education, and numerous other related programs. I have been working in the peer education department on modules on gender and HIV, gender-based violence, post-trauma and psychological problems, and community mobilization. I take materials from the existing Rwandais materials, the Hesperian foundation, other NGOs, and numerous other sources and compile them into one enormous and growing document. Then I edit for language simplicity and continuity, add photographs, and do lots of research into the Rwanda-specific components. This is usually information on available services, specific practices, coping strategies and social norms. I was hoping to get the chance to rigorously test the modules, but that is apparently not in the cards… they are currently about 130 pages long in total, and I have a lot to do this week!
When they have been finished and field-tested, the modules will be sent to the Centre National en Lutte le SIDA (the national center for the fight against AIDS). Hopefully they will be reviewed an approved for use as a national curriculum by anyone who wishes to use them. My boss and I have also been lining up partner organizations to use these modules. So far it looks as though the national network of people with HIV, the national nurse’s network, WE-ACT, the UNHCR subcontractors who work in the refugee camps, several of WE-ACT’s partner associations, possibly an association that does work with prostitutes, and possibly by two groups in the Democratic Republic of Congo (Action AID and HEAL Africa). In addition, I wrote a small report on gender-based violence in the North-Kivu district of Congo, as WE-ACT may be starting programs there.
I think the most interesting part of my work here has been learning about post-traumatic stress disorder, and its treatment. As one of the modules focuses on this, I have spent some time with WE-ACT’s trauma counselors as they interview women. This is obviously rather emotionally taxing. Trying to relay these stories in any but the most superficial way is practically impossible. I feel the need to retell these stories, at the same time as I recognize that they are personal and confidential and painful. Furthermore, suffering does not make for good literature. Nothing I had read before coming here prepared me for the reality of hearing these stories from people’s mouths, and I feel it is beyond my capacity as a writer to relay them in any meaningful way. As I was working on the section on ”compassion fatigue” (PTSD symptoms from hearing other people’s trauma stories) I began mentally checking off symptoms, and I decided to travel to Uganda and the DRC to get some space.
WE-ACT is starting a PTSD program with selective serotonin reuptake inhibitors, or SSRI’s (like Prozac). I did some research into how to get these medications cheaply from Indian manufacturers or through the International Dispensary Authority. Delphine, the patient and friend mentioned in earlier blogs, is in need of Prozac. While I was in Uganda I purchased a years worth of these meds for her so that she might have a supply before WE-ACT starts the programs. The dearth of psychological medications and services for survivors in Rwanda is appalling, and the number of people who have used “cost effectiveness” as an excuse for why good psychological medications are not available is horrifying. The cost of generic Prozac is roughly $25 dollars per person per year, and the impact that this medication can have on the lifestyle and work potential for a PTSD sufferer is extraordinary. Getting medications for Delphine was perhaps one of the most rewarding parts of my experience here. It has affirmed in my mind that I really value the individual interaction in international work, and that I really do want to go to medical school one of these days.
Posted by Caitlin Lee Cohen at August 31, 2007 04:02 PM
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