Sitting astride a strategic ridge halfway up a mountain in the center of East Africa, Kigali, the increasingly dynamic capital of Rwanda, is part of the whole new world. Yet, corner of bandages hanging from a pole among a cluster of huts, Kigali is in a sense the same old place. A stream meanders through the center of Kigali, east Africa’s main artery, but its banks are overgrown with weeds. At daybreak and dusk, its waters are green and filthy. The scars from decades of ecological damage linger: many people in Rwanda suffer from tropical diseases such as malaria, schistosomiasis, and lymphatic filariasis. Over the next year, I traveled to eastern Africa to listen to the stories of a country whose present is closely tied to its past. I went to Kigali to hear the stories of those on the frontlines of modern public health: those battling to improve public health systems to prevent and treat intractable tropical diseases.
A Glimpse into Kigali’s Tropical Disease Landscape
Tropical diseases are widespread in sub-Saharan Africa, the region where Rwanda is located. Despite impressive improvements in healthcare, they remain a major public health issue. Malaria, for example, is seasonally endemic, with annual outbreaks affecting many thousands of people. Schistosomiasis, a disease caused by flatworms, and lymphatic filariasis, a debilitating parasitic infection, are particular concerns.
The Rwandan government, together with several international organizations, has commendably focused on preventing the spread of the diseases through treatment programs and public education. But it is a fight with numerous pitfalls – the voices of those working at the sharp end are a vital source of insight.
Triumphs and Challenges: Personal Stories from Kigali
1. Dr. Jean-Paul Niyonsaba: A Visionary in Malaria Control
Dr Jean-Paul Niyonsaba is a long-time physician and malaria researcher in Kigali, Rwanda. He oversees the patients and studies of ‘malaria workers’, the army of medical experts trained to administer treatments and collect crucial data on malaria deaths in the region. He has seen his fair share of triumphs and challenges in the growing struggle against malaria in Rwanda.
- Victory: Dr Niyonsaba’s work has led to the adoption and expansion of insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS) and is associated with a fall in malaria incidence in Kigali over the past decade. ‘The introduction of ITNs and IRS has been transformational,’ he says. ‘Malaria cases have fallen considerably, and it’s just fantastic to see the effect on the families.’
- Challenge: ‘Insecticide resistance is a growing problem,’ Dr Niyonsaba explains, ‘so we need to keep finding new ways to stay ahead of parasite changes, and that means more and better research. Another challenge is that these programs are expensive and depend on our society accepting the value of innovation.’ Time and a persistent lack of resources pose additional hurdles. ‘We don’t only need immediate financial support,’ Dr. Rudatsikira stresses. ‘We also have to conduct education and outreach at the community level.
2. Aline Uwimana: A Community Health Worker’s Journey
There’s Aline Uwimana, Kigali’s rural outskirts’ frontline malaria-preventer: a community health worker who educates, distributes ITNs, and monitors cases.
- Victory: Aline’s persistent efforts have fostered greater awareness and prevention in her community. ‘I’ve seen first-hand how education and the use of prevention can influence thriving living,’ she says. ‘With the bed nets, I have seen within my community the reduction in malaria cases with families that always use their bed nets.’
- Challenge: Aline faces the challenge of traveling to remote areas, and also encounters resistance from some community members who feel that preventive measures are unnecessary. ‘Sometimes it can be difficult to convince people to use bed nets or to stick to treatment protocols,’ she says. ‘We need to have more resources and support. It is not easy.’
3. Jean-Baptiste Hakizimana: Overcoming Schistosomiasis
It has made his penis twice its normal size.’ Jean-Baptiste Hakizimana, a 35-year-old farmer from Kigali’s rural outskirts, knows enough about the illness. He’s been living with it for years. Caused by parasitic worms, and often found in Asia and parts of Africa, schistosomiasis mainly attacks the bladder. If left untreated, it can cause urination problems. Hakizimana undergoes treatment at least once a year to remain clean, but his friend remains chained to his condition. ‘He’s helpless,’ Hakizimana tells me. ‘It has made his penis twice its normal size.
- Success: Jean-Baptiste is a success story. He received a six-month course of treatment in a government-run program, and he’s better for it. ‘I was in a bad way for years, but the treatment saved me. Now I work, and so do my children, and I can provide for my family without shying away due to pain and fatigue.’
- At the same time, Jean-Baptiste acknowledges that tackling schistosomiasis remains a work in progress. ‘For some of the people living in remote areas, access to treatment is still an issue,’ he says. ‘The infrastructure to guarantee that people have access to treatment as well as awareness of schistosomiasis as a disease is still not there.’
4. Marie-Claire Uwase: A Mother’s Battle with Lymphatic Filariasis
Marie-Claire Uwase, a 40-year-old mother of three, felt trapped by a disease known as lymphatic filariasis, which causes painful swelling of the limbs and can significantly impair quality of life.
- Victory: Marie-Claire was helped by an elimination program for lymphatic filariasis, in which drugs and services are provided to those affected. She says: ‘The medication helps me to get by from day to day and improves my wellbeing. Thank you for the assistance and treatment.
- After living with those symptoms for years, Marie-Claire thinks she needs support and education for a lifetime. ‘To be cured from lymphatic filariasis often takes continuous care, which may not always be available to everyone. People should be better educated about the disease and have better access to treatment options,’ she says.
Efforts and Initiatives in Kigali
Kigali’s battle against tropical diseases involves a multifaceted approach, including:
- Government Programs: Very extensive government programs have been deployed in Rwanda against tropical diseases. These include mass medical (MDA) campaigns, vector control measures, and public health education programs.
- Partnerships with NGOs Likewise, partnerships with international organizations and nongovernmental organizations (NGOs) play a pivotal role in the provision of resources, financing, and technical support in disease control efforts. In combating these diseases, collaborations with organizations such as the World Health Organization (WHO) and Médecins Sans Frontières (MSF) have been paramount.
- Community Engagement: Successful programs engage local communities in prevention and treatment efforts. Community health workers such as Aline Uwimana are key to connecting those in need with the health services available to them.
- Research and innovation: Research and innovation also play an important role in the control of tropical diseases. Developing and improving drugs, and diagnostic tools, and understanding disease dynamics help healthcare workers design more effective control systems.
Looking Ahead: Future Prospects
The Kigali tales illustrate this progress but also the obstacles to defeating tropical diseases as the city continues to evolve. Several important fronts will be critical to future success.
- Strengthening Health Systems: Boosting funding for infrastructure, training, and supplies to strengthen the overall capacity of our health systems to tackle these or any other diseases more effectively.
- Increase access to treatment Increasing access to testing and treatment services, especially in remote areas, will improve outcomes for many affected individuals.
- Improving Community Education: Prevention techniques are more effective when continually educated and engaged with communities, which in turn increases treatment adherence.
- Supporting Research and Innovation: We must continue to invest in research and the development of new tools and the best strategies to reduce disease.
Those voices from Kigali are a reminder of the human face of the struggle against the diseases of the tropics. The defiant, weary, and sometimes lonely memories of triumph and failure illustrate the realities of those on the frontline of disease control and pave a path forward in the struggle to shake off the specters of our enduring tropical diseases.
