Online Extra: First Aid for Rwanda

Dr. Paul Farmer has a plan to alleviate the country's critical condition -- and his lifelong work in other poor countries provides good reason for optimism

There are few countries in more desperate shape than Rwanda. This densely populated African nation is one of the poorest on earth, and has yet to recover from the genocide of 1994, when 800,000 to 1 million Rwandans -- 10% of the total population -- were murdered in just 100 days. Now, some 9% of the population has AIDS or is HIV positive, the average life expectancy is 49, and there's only one doctor for every 30,000 people. Even so, the country is implementing an electronic medical records system to track the treatment of all AIDS patients, a technological advance rarely found in the U.S.

This is just one sign that Dr. Paul Farmer is on the case.

Farmer, a professor at Harvard Medical School, has made it his life's work to correct the inequities in health care. He abhors a situation, common around the globe, in which the gap between the richest and poorest nations translates into disease and early death for those on the wrong side of the divide.

ROOT PROBLEMS.

  Farmer and the foundation he helped start, Boston-based Partners in Health, pioneered community-based health interventions in Haiti, Peru, and Siberia that have grabbed the attention of governments, charities, and the United Nations. Now, they're bringing those methods to Rwanda. In April, 2005, with funding from the Clinton Foundation and the cooperation of the Rwandan government, Partners in Health announced the formation of Inshuti Mu Buzina (Partners in Health in Kinyarwanda). It targeted the remote Rwinkwavu and Kirehe districts, where 340,000 people lived with no doctors until Farmer and his team arrived.

In the past year, they have restored an abandoned hospital, recruited a staff of some 150 doctors, nurses, and lab technicians, started caring for more than 1,000 AIDS patients who were previously untreated, and trained scores of locals as health-care workers. The hospital has also been linked through the Internet to five affiliated clinics, part of Farmer's belief that health needs can't be met without also addressing the poverty, living conditions, and lack of infrastructure that caused many of those health problems in the first place.

To correct those underlying conditions, Farmer is working with the Rwandan government to make sure national health care systems are established. Standardized protocols have been developed for the treatment of AIDS, tuberculosis, and other infectious diseases, and programs have been launched to provide health insurance and proper nutrition to the poor, and place children in schools.

LEARNING CURVE.

  The latter provision is especially critical because community-based care relies on a novel infrastructure in which neighbors look after neighbors. This system flourishes in an environment where individuals have enough education to understand both the goals of the program and the mechanisms to carry them out.

Farmer, 46, has spent almost half of the past year in Rwanda, making for an even more complicated schedule than he normally follows. His wife and eight-year-old daughter live in Paris, he still regularly returns to Haiti to treat patients, and he's on the staff of Brigham & Women's Medical Center in Boston. But Farmer says his work is far from over in Rwanda. Over the next two years, Partners in Health hopes to open a second hospital and establish a training center for AIDS and tuberculosis health workers. Farmer also wants to expand into other African nations.

To many in the industrialized world, his efforts may seem almost futile, given the crushing poverty and ongoing violence in Africa. Ten years after the Rwanda genocide, a similar slaughter is taking place in Darfur. But Farmer refuses to become disheartened by Darfur. "This time, the world is responding a lot faster to the genocide. I think we have learned something." If we have, it's in part because of the example set by Dr. Farmer.

By Catherine Arnst

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