Posts published by Josh Ruxin

46 Results

Step One to Fighting Ebola? Start with Corruption

The story of the current Ebola pandemic appears still in its opening chapter. Will the virus be contained, or will it spread its horror across Africa and beyond? The question is being raised around many family tables, including ours, particularly as my wife and I and our three small children, New Yorkers, live in Rwanda where I work in public health and she operates a job training program and a gourmet restaurant. There is a bit of fear in the air here as everywhere, but it is tempered by what we know about Africa.

Since March, more than 4,000 people, including over a hundred medical workers, have died of the Ebola virus in Western Africa. Why have the health systems in these countries, after billions of dollars in international aid, lost control of this modern plague? For starters, most African nations scarcely have anything we would call a health system, despite aid programs and waves of dedicated medical and development volunteers. As fast as we can pour resources in, the thousand cuts of corruption and poor business practices let it leak out. Like Ebola itself, corruption is a hemorrhaging disease. When aid programs fail because of corruption, further aid programs are discouraged. Ultimately, little health clinics with empty shelves, peeling paint and no staff are left to rot under the jungle trees.

Photo
A mother speaks about her baby's immunizations and weight with a nurse at the Gataraga health center in Musanze, Rwanda.Credit Gadi Habumugisha

I have seen those pathetic health facilities, but in Rwanda I’ve seen them cleaned up, restocked with the best medicines, nurses and doctors, and now prepared for what may come this way from West Africa. What has been done in Rwanda, however, is not possible in countries rife with corruption. Here in Rwanda, no one has ever put a hand out to me for a bribe – not once in the near decade I’ve lived here. That lack of hemorrhaging is what will enable us to stop Ebola here. Ebola is a marker for corruption on high, just as entrenched poverty is a marker for corruption on high. In the great influenza plague of 1918, when twenty million people died worldwide, the great difference between a country that suffered greatly, like India, and a country that suffered little at all, like Denmark, was the strength of the middle class. The strength of the middle class is most commonly a function of public and private health, and clean, just governance.

Photo
A nurse-midwife monitors a fetal heartbeat.Credit Gadi Habumugisha

If we want to get serious about addressing the current and coming plagues, we must create universal access to quality health care, and that is only possible if the corruption that is now taken so much for granted in poor countries is eliminated. According to Transparency International, Guinea – the origin of this pandemic – is ranked 150 out of 177 countries for corruption, while Sierra Leone is ranked 117 and Liberia is ranked 83. Improving the health systems in the most corrupt and poorest nations should be at the top of our To Do list. Taking actions is not simply the moral thing to do, it’s in our own best interest. Let’s start now, before the next virus, perhaps many times more communicable, rises up to challenge us all.

Of course, corruption is not entirely to blame. Many Asian nations were famously corrupt while channeling substantive resource to build out their infrastructure and health systems. There’s an old development joke about a couple wealthy guys – one from Africa, one from Asia – who go to university together and years later meet up in their respective nations. The African arrives at the Asian’s residence – a massive estate with a few smart cars in the driveway and remarks, “You’ve done well, how’d you do it?” The friend replies, “You notice that superhighway you rode in on from the airport?” “Yes, it was stunning!” “5 percent of that project went in my pocket.” A few months later the Asian finds himself in Africa and heads out to his friend’s residence. It’s gigantic with dozens of Rolls Royces and sports cars scattered around. “Wow, I thought I had done well, but you’ve certainly beaten me. How’d you do it?” The African responds: “See that superhighway you rode in on?” “No,” he replies, “The road was atrocious!” “Ahh,” replies the African, “100 percent of that project in my pocket!”

Rwanda certainly doesn’t fit the caricature. My wife and I are encouraged by what we have seen here. Soon after the close of the 1994 genocide, the government of Rwanda recognized that health is, literally, wealth, and set out to refurbish and build out several hundred facilities across the country. Today, twenty years on, its national health insurance program enables citizens to access regular lifesaving treatments without going into destitution. Its maternal and child health have, arguably, improved faster than in any other country, ever. Its health care system has become adept at handling HIV by offering free testing and treatment with no waiting list for drugs. The system is quick on its feet, well connected with communication and ambulances to handle new disease threats. Indeed, national community initiatives such as Umuganda (a monthly day of service) are already educating the population about best hygiene practices. Most importantly, the people trust the medical system and the government. Panic is the greatest threat to the containment of a pandemic. Panic happens easiest where there is little trust.

Photo
A woman receives medication at a health center pharmacy.Credit Josh Ruxin

What’s needed today is agile funding for health systems, both public and private. Where corrupt ministries are bound to squander funds, private centers must be built and staffed, funded by private donors and forward-thinking foundations. Where well-meaning ministries exist, their efforts must be bolstered with technology and management interventions – good, American-style management systems, such as the ones introduced so successfully in Rwanda. At the same time, international pressure against corruption in poor nations must finally begin in earnest. In the long run, that will do more than all the aid groups can achieve. Where corruption is ended, prosperity thrives, and in a prosperous land, people can afford their own family health care. That is when they are safe from such things as Ebola. When they are safe, we all are safe – and only then.

Corruption and Ebola are essentially the same hemorrhaging disease. If we cure corruption, we will have the healthy planet we all truly want and our children deserve.

Josh Ruxin is the author of A Thousand Hills to Heaven: Love, Hope and a Restaurant in Rwanda and executive director of Health Builders.

Africa’s First World Problems — and Opportunities

Nakumatt is East Africa’s version of Walmart — with an elephant as its symbol.Jenn LeeNakumatt, the store pictured here in Kigali, Rwanda, is East Africa’s version of Walmart — with an elephant as its symbol.

It won’t be long now before the horrors at Westgate Mall in Nairobi are out of the headlines and relegated to the annals of horrible terrorist attacks (and possibly intransigent police corruption and ineptitude).  Here in Rwanda, a nation that has, against the odds and prognosticators, moved farther beyond one of the greatest tragedies in recorded history, my friends and colleagues see Westgate as a wake-up call to start paying more, and different attention, to this part of our precarious world.

On our smartphones and tablets, we were troubled to see the Twitter responses to the terrorist attack, best summed up by this tweet: “Wait, they have malls in Africa?”  Precisely.  Africa has made astonishing progress in the past decade with some of the highest economic growth rates in the world.  (I am proud to live in Rwanda, which clocked in as the one of the ten fastest growing economies this year).

 

 

Yes, Africa has malls, and entrepreneurs, and by some accounts the world’s fastest growing  middle class.  But by the headlines, you would think it a lost and desperate place, riddled by HIV/AIDS, malaria, and tuberculosis.  Certainly, these killers have wreaked tremendous harm, but increasingly, the diseases of the rich nations – diabetes, cancer, and heart disease – are claiming more lives every day as health systems struggle to keep on top of these emerging pandemics. East Africa, wouldn’t you know, is starting to look a lot like everywhere else.

Westgate provides proof positive that we’ve got to start treating the nations of Africa for what they are: emerging economies home to a huge and growing middle class (estimated to hit 1.1 billion by 2060).  It’s no longer about “saving them”– it’s about helping them grow.  But now the region also faces what are typically seen as “first world problems”: education, access to capital, business capacity, security, and counter terrorism measures.  It’s time to take Africa out of the “primitive” box in the global mentality, and to put it where we see Southeast Asia today – a source of wealth, growth, and ingenuity, and a major player in the 21st century.

At moments like this when the insanity and cruelty of humanity overwhelms, I hope that attention can be placed on the possibility and the promise of the deeply different and often forgotten nations on this continent.

Josh Ruxin is on the faculty at Columbia University and is author of the forthcoming book, A Thousand Hills to Heaven: Love, Hope and a Restaurant in Rwanda

 

Time to Face the Pain

A doctor treats a patient in pain in Kerala, India.Moonshine Agency A doctor treats a patient in pain in Kerala, India.

Last year in Mexico, just a couple of days into my vacation, I fractured my kneecap. In the emergency room, through pain so severe I found myself yelling at all helpful parties around me, particularly my wife, the doctors noted that they did not have painkillers to send home with me. “WHAT!?” I screamed. “No oxycodone, hydrocodone, nothing?” They explained that Mexico’s drug laws had grown so strict due to the actions of the narcotraficantes that pain meds were tough to come by (and only provided to patients who had been admitted to the hospital).

Two days later at the airport, the gate agent for American Airlines nearly refused to let me fly because she could see how much pain I was in and thought I might force the plane to make an emergency landing. After much haranguing I was finally allowed to board and made it back home for surgery and painkillers. But this incident compelled me to look at the state of pain management in developing countries.
Read more…

Reversing the Brain Drain: Expanding Medical Opportunities in Rwanda

Gitwe Hospital, a regional hospital in Southern Rwanda and one of the many projects spearheaded by Gerard Urayeneza, a Rwandan who is committed to expanding medical capacity in his native country. John StreitGitwe Hospital, a regional hospital in Southern Rwanda and one of the many projects spearheaded by Gerard Urayeneza, a Rwandan who is committed to expanding medical capacity in his native country.

For decades, young doctors and nurses have been fleeing poor countries for the bright lights and fat paychecks of wealthier nations, abandoning the parts of the world with the highest burden of disease and most desperate need for medical help. Sixty percent of medical doctors who trained in Ghana in the 1980s have since left the country, and there are more Ethiopian doctors in Washington DC than in all of Ethiopia. Sub-Saharan Africa today houses more than a tenth of the world’s population, and shoulders a quarter of the global burden of disease, but it has just three percent of the world’s health care workers.

That said, some young Africans have broken the mold.

Read more…

A Low-Impact Stove for Rwanda

Eric Reynolds, co-founder of the outdoor sports gear company Marmot, with the cookstove he wants to distribute for use in Rwanda. Jonathan Kalan/The (BoP) ProjectEric Reynolds, cofounder of the outdoor sports gear company Marmot, with the cookstove he wants to distribute for use in Rwanda.

Last year, Eric Reynolds, the co-founder of the outdoor sports gear company Marmot, contacted me with an aggressive business plan for rolling out fuel-efficient, low-pollution cookstoves across Rwanda. Having seen dozens of entrepreneurial projects in Rwanda start with a big bang and then founder for lack of momentum and commitment, I initially brushed off his enthusiasm. I gently explained that he would have to move to Rwanda if he was to get anything done, and he explained that this was exactly his plan.

When Eric rolled into town a few months later and announced that he had decided to, in his words, “spend life here,” I was pleasantly surprised.

Read more…

Where the Grid Will Not Go

When an Italian priest and his cadre of nuns founded the Munyaga Health Center in 1986, it was a barebones operation. Tucked among the rolling green hills and small mud homes of eastern Rwanda, the health center had limited services; the nearest source of potable water was five miles away, and kerosene lamps were often the only source of light. The center’s most expensive technology was an array of solar cells to provide power for part of the day.

Read more…

Girls in the Spotlight: A Lesson from Rwanda

School girls at the Gashora Girls Academy, which opened in March, 2011. Mike McCausland/Rwanda Girls Initiative School girls at the Gashora Girls Academy, which opened in March, 2011.

When I try to get people interested in the education cause in Rwanda, they often tell me that they’re up to their eyeballs in work on public or charter schools in their own neighborhoods – Upper West Side, Noe Valley, wherever. Some people, though, have a broad definition of “neighborhood.”

A couple of years back, two women from Seattle approached me about the possibility of establishing a girls’ school here in Rwanda. I’ve grown accustomed to receiving countless entrepreneurial inquiries from well-meaning people and seeing little come of them, so I must admit that my first reaction was skepticism.

Luckily, Soozi McGill and Shal Foster defied my initial doubts and have followed through on their plans with aplomb. While training together for a marathon in the United States, the two long-time friends found themselves discussing the high-quality education that their own children were receiving. From there, they started to form a vision to help children who had not been born so lucky.

Read more…

A Cause and a Solution for Haiti

So far, the news from Port au Prince is grim: cholera infections are on the rise across Haiti, more than 2,000 people have died, and the end is nowhere in sight.

Read more…

A Sugar and Salt Solution for Haiti’s Cholera Epidemic

Twenty years ago I witnessed what seemed to be a medical miracle in a village deep in Bolivia: a nearly lifeless child dehydrated by severe diarrhea was given sips of a sugar and salt solution and recovered in a couple of hours. Curious about this simple yet lifesaving mixture called oral rehydration solution, I learned that United States-funded scientists had discovered it in 1968 in then-East Pakistan as a simple, cheap alternative to intravenous treatment. Defying all expectations, the researchers learned that at the right proportions, oral rehydration could resurrect even severely dehydrated adults suffering from cholera.

A child with cholera receives oral rehydration solution, a mixture of water, sugar and salt, at a hospital in Bangladesh. Josh Ruxin A child with cholera receives oral rehydration solution, a mixture of water, sugar and salt, at a hospital in Bangladesh.

At the “Cholera Hospital” (as its affectionately called) in Dhaka, Bangladesh, I’ve seen infants survive the worst cholera symptoms thanks to spoonfuls of solution administered tenderly by their mothers. Remarkably, the solution is effective even when it must be mixed with dirty water. That’s in great part why the scientists that discovered this breakthrough treatment are frequently nominated as recipients of the Nobel Prize in Medicine.
Read more…

Rwanda’s Road of Progress

For years, my family and neighbors have shared a joke about our little dirt road in the center of Kigali. “Rue de Progrès” (Road of Progress), we chuckle, has really been “Rue de Non Progrès” (Road of No Progress).

Josh Ruxin’s daughter walks along the Rue de Progrès in Kigali. Josh Ruxin Josh Ruxin’s daughter walks along the Rue de Progrès in Kigali.

We love our dusty, muddy road, affectionately called “bumpy” by our 3-year-old daughter. Every afternoon our two daughters run up and down it freely, picking flowers. When cars make their way slowly up the cratered street, the girls have plenty of time to move safely to the side. But that’s all about to change. On a recent morning I spotted the ominous sign of surveyors carefully pegging the spots where asphalt will soon cover our familiar red dirt. Just like Rwanda, our road is transforming right before our eyes.

Read more…

AIDS Is Still a Crisis. Is Anyone Really Surprised?

Josh Ruxin is the director of Rwanda Works and a Columbia University expert on public health who has spent the last few years living in Rwanda.

Donald McNeil’s recent reporting in The New York Times has abruptly reminded Americans of a reality that’s already painfully clear to millions on the ground in Africa: current efforts to fight AIDS aren’t good enough.

McNeil has drawn attention, in particular, to the thousands in Uganda who have tested H.I.V. positive and are then denied treatment. These individuals are at the back of an unfathomable queue, and they only move up into the ranks of those who receive anti-retrovirals when an opening is created by the death of someone already receiving treatment. It’s heartbreaking, but shouldn’t be at all surprising to those watching the global numbers and patterns. Read more…

16 Years after the Genocide, Rwanda Continues Forward

Josh Ruxin is the director of Rwanda Works and a Columbia University expert on public health who has spent the last few years living in Rwanda. Here he reflects on the anniversary of the genocide in Rwanda.

Today is the 16th anniversary of the start of Rwanda’s genocide, three months of brutality in which an estimated 1,000,000 people were killed. As I’ve previously written, Rwanda has rebuilt itself in the aftermath of that tragedy, setting itself apart from other developing nations by intelligently, efficiently, and transparently making the most of other nations’ investments and creating the building blocks of success in agriculture, social services, entrepreneurship, and basic infrastructure.

Central KigaliJosh Ruxin Central Kigali

From AIDS to family health, you’d be hard pressed to find a nation that’s shown better results for the money spent in improving health care fundamentals. Nevertheless, getting those basics right are only the foundation of the nation’s broader plan to become a middle-income country by 2020. That’s right: 10 years from now, Rwanda intends to be on par with Brazil, Thailand, and other nations that have pulled themselves out of poverty in recent decades.

Read more…

This Year in Kigali: A Rwandan Seder

Josh Ruxin is the director of Rwanda Works and a Columbia University expert on public health who has spent the last few years living in Rwanda. The following is an account of a Seder he recently celebrated in Kigali.

Seder in Kigali, Rwanda. Josh Ruxin Seder in Kigali, Rwanda.

Passover preparations are underway here in Kigali, where it seems a disproportionate number of the social entrepreneurs and development workers are Jewish. For the fifth year in a row, we’ll be sharing this holiday with our friends in Rwanda. We’ve mastered the art of home-baked matzo, printed up internet-available Haggadahs, and gotten over our longing for sweet kosher wine on the table. Unlike Ethiopia, and many other countries in Africa, there is no synagogue here and the community is fragmented. But the spirit of Passover is particularly strong. The holiday takes place just a few days from the start of the national commemoration of the 16th anniversary of the Rwandan genocide.
Read more…

6,000 Kids Saved This Year in Rwanda

josh

Josh Ruxin is the director of Rwanda Works and a Columbia University expert on public health who has spent the last few years living in Rwanda. He’s an unusual mix of academic expert and mud-between-the-toes aid worker. He has made great contributions to this blog for nearly two years. This will be his last entry.

As the media turned world attention to efforts to contain a swine flu outbreak, the headlines reminded us of the unprecedented rate at which infections can travel the globe today. Yet, over this same period, in the small corner of the world I occupy, I was reminded of the extraordinary promise that globalization holds to more rapidly disseminate solutions –- not just problems –- in public health.

On April 25, Rwanda became the first developing country in the world to launch a national immunization program against pneumococcal disease. The program will administer Wyeth Pharmaceuticals’ Prevenar®, a pneumococcal conjugate vaccine (PCV), to nearly all Rwandan children less than a year old by the end of 2009 and all Rwandan infants on a routine basis thereafter, free of charge.

This move will start saving approximately 6,000 kids’ lives per year in Rwanda. This is not just good news; it must count as a major development in global public health.

As Nick discussed in his op-ed of May 10, pneumococcal disease attracts negligible investment, making it the orphan of global health. But it is vitally important that this change, as, in his words, in the five minutes it took to read his column, at least 19 children died of pneumonia, more than died in the same period of AIDS, malaria and measles combined. Read more…

4 Million Kids in 4 Days

josh

Josh Ruxin is a Columbia University expert on public health who has spent the last few years living in Rwanda. He’s an unusual mix of academic expert and mud-between-the-toes aid worker.

During the last week of March, nearly 4 million children were treated for the two most prevalent and debilitating parasitic infections in Rwanda in the course of just four days. If that sounds like a major undertaking, it is.

The Herculean nature of this task can’t be underestimated: Distributing drugs to 1,998 different sites across a country characterized by steep hills and few paved roads is a logistical feat in itself. But getting the word out; convincing parents to take days away from their field work to bring their children to a health center; training teachers to administer the drugs in thousands of schools; convincing children to swallow pills that may cause temporary side effects, which include stomach pain and itchy skin: All this required an ambitious and broad communication campaign and a small army of dedicated people to skillfully carry it out.

It is about time this happened. Little was known about the prevalence and intensity of parasitic and bacterial infections in Rwanda just two years ago, but the crippling nature of these disorders was graphically demonstrated on a daily basis. In fact, until 2005, little attention was paid by the global health community to the parasitic and bacterial infections that are the most common chronic infections among the world’s poorest people. As a result, 13 of these infections have been labeled “Neglected Tropical Diseases” or NTDs. Read more…