A Life Less Ordinary
Organized by: Sharon Johnson
In 2004, Richard was a young British doctor struggling with who he was, what he was doing and where his life was taking him. He had spent many years training to be a surgeon, living a good life and dealing with everyday pressures. However, he was not fulfilled, he was feeling lost and decided to turn his back on a career that had consumed the last 10 years of his life and went in search of something else. Chance events in that search led him to a tiny part of the Dark Heart of Africa. In July of that year, after having studied Tropical Medicine in Liverpool in the UK, he was met by an American physician at the airport in Kigali, the capitol of Rwanda. About the size of Wales and Belgium, or half the size of Tasmania, Rwanda has a population of approximately 11 million people that crowd the steep but lush and fertile slopes of the ‘land of a thousand hills’. Richard’s plan was to spend three months working in a mission hospital in the far West of the country in a village called Mugonero. The hospital had around 100 beds, depending on how many mattresses were laid on the floor. The medical staff consisted of Dr M Ranzinger, the American physician and one other Rwandan doctor. Most care was provided by nurses, the washing and the preparation of food carried out by patients’ relatives. Within days of Richard arriving it was evident that his life had changed and he almost immediately extended his time in Mugonero to nearly six months. In that six months Richard began a social, psychological and emotional journey that changed not only his life but others also and this journey continues to have far reaching effects today. Working in an environment of extreme poverty with minimal resources and clinical conditions that are not seen in the modern developed world, helped Richard realise that one person can have an impact and that had a profound effect. He was accepted into a community and a family of vibrancy and love and here he believed he belonged. Cases were diverse and often very new and confronting. These included the delivery of babies by caesarian section, operating on infected bones and children with typhoid. To see children die of diseases that we have largely eradicated with immunisation in the developed world was heartbreaking. Children had to carry water for one and a half hours from the nearest (unsafe) source to their home and then walk the same path to church on a Sunday. Not all of it was difficult however. Richard got to explore the rainforests with the kids of his new “adoptive” family and experienced the wonder, interest and intrigue of the local population. A Catholic Mother Superior handed out contraception, against the teaching of her calling, because it was the right thing to do. And then on 24 July a grieving father left his baby girl at the hospital, after having watched his wife die during unassisted childbirth in their home. The baby was very premature, weighed a tiny 900g and was not expected to survive. She was placed in the sole incubator of the hospital’s maternity room by the nursing staff to be palliated. By chance Richard happened to walk through the maternity room despite thinking there were no patients in there to be seen. At this time Richard had no neonatal training and little paediatric experience but despite this he was determined that he would not let this precious baby girl die. There were many challenges to overcome. The incubator in which she lay was dependent on mains electricity that, in Mugonero, was running only about 50% of the time and the nights at that altitude are cold. The baby was too weak to suckle, there was no medical equipment small enough to provide any intravenous treatments. There was no formula to feed to premature babies and there was a huge lack of knowledge and experience. But Richard would not be deterred. The baby was Kangaroo nursed, fed with home made soy, olive oil and sugar formula and treated empirically with subcutaneous injections of medications in minuscule doses when sickness threatened her. Initially she was fed by naso-gastric tube. A roster of feeding was designed with an American volunteer, a pre-medical student visiting for a couple of months and the nursing staff provided much needed relief when Richard was needed elsewhere. Slowly she started to gain weight and develop some energy for life. After about six weeks, in the middle of a ward round, carried Kangaroo style she was suddenly strong enough to cry. At that moment Richard also cried because he suddenly realised that this tiny baby might survive. Four months later, Richard was preparing for his departure but the baby was still very much like a newborn baby and only weighed 2kg. At that stage the local orphanage, L’Esperance children’s village had no capacity to look after her. They could not take children under the age of 18 months. So, in conjunction with the hospital and the orphanage it was decided that a surrogate carer would be employed to look after the baby until she was old enough to enter the orphanage. Richard left as much money as he could with the Director of the orphanage to pay for the surrogate and pledged to send more as needed to secure the baby, who Richard named Rebecca[s}, future. It was here that Richard and Sharon married and most of the community attended. We were blessed under the boughs of a giant and ancient cotton wood tree of the rainforest. We both then returned to the UK and Richard enrolled in Emergency Medicine training. We now live with our two beautiful daughters in Alice Springs, Central Australia where Richard works as the Director of Aeromedical Retrieval providing high level medical care and rescue to remote and mostly Indigenous Aboriginal communities in the outback. Meanwhile, in Rwanda there was a realisation that Xavarine, the lady employed to care for Rebecca could look after others and with funds left by Richard and others raised from a variety of sources the Baby Project was added to the orphanage as a separate but linked entity. Over the next 9 years more than 23 babies were admitted to the Baby Project. Sadly some of these babies did not survive but most thrived and were given the chance of a life they did not have before. We kept in contact and friends and family helped to raise funds. We returned to Mugonero with our first-born child when she was 18 months old, just as we had promised the hospital staff that attended our wedding. Rebecca was now two and a half. We stayed in touch and watched Rebecca grow from afar and indeed attempted to adopt her but were thwarted by bureaucracy and politics. Over the years the pressures and politics in Rwanda changed and communication became very much more difficult with the orphanage. Contact was lost around 2012. In 2014 UNICEF and USAID as part of the ‘Better Care Network’ presented a paper to the UN which stated that institutional care was damaging for children and that they should be cared for in a family home. The Rwandan government took that word for word and commenced a program to close all orphanages with the aim of settling children with relatives or other families in the villages from where they had come. It is easy to state in a developed world framework that institutional care is harmful but when this care provides shelter, food, clothing, schooling and constant, predictable and dependable adult support against the alternative that can sometimes mean poverty, hunger, no education and often violence and exploitation it may be a vastly superior alternative. It must also be understood that a culture like Rwanda does not require both parents and all close family to die to produce orphans. Poverty, social reasons and an inability to care for a child may result in its entry into an orphanage. These children are there because they would not have survived otherwise for many different reasons. L’Esperance is now closed. The children do not go to school and they miss their friends and the people whom they understood to be their family. Many are now hungry. When we heard that the orphanage was to be closed Richard and Sharon increased their attempts to find news of Rebecca and thankfully came across the Facebook page of a Dutch journalist who was setting up a project to support schooling (but only covering school fees) of a small group of the disenfranchised ‘ex-orphans’. Through this journalist the couple received the contact details of an old friend, Prince, who spent his time looking for Rebecca. She was back with her father who, when he heard that the orphanage was to be closed, came for her. Of course our first thought is that this is excellent news. However, he has since suffered further tragedy. His second wife also died. (Life expectancy in Rwanda is around 40 years and a woman has a 12% lifetime risk of dying due to pregnancy related complications). Rebecca now lives with him and his third wife and 5 other children, in a single room, mud brick hut with no bathroom or kitchen. They cook on an open wood fire and have significant food insecurity. They sleep on the dirt floor, which is damp in the wet season and dusty in the dry. She does not go to school anymore. She has recently been hospitalised with cholera during a local outbreak due to the only water source being untreated lake water. We have sent some money to Prince to buy a mattress, some emergency food and a chicken for eggs but this is barely a scratch on the surface. Rebecca is not included in the back to school project that the journalists set up as she left the orphanage before it was set up. We intend to pay for her schooling and hopefully that of her siblings. UPDATE: Richard visited Rwanda in November 2015 to find out if there are any sustainable projects that can be started to assist the families and communities of the children. If the children are to get to school they and their families must have the means to send them. They must have enough food so that the child does not have to work in the fields and they must have fuel so the child does not have to forage for wood. They must have water so that the child does not have to walk to and from the lake several times per day. Basic things that we take for granted can help to change lives by supporting education in an attempt to break the cycle of poverty and allow these children a chance of a choice in life and to achieve something of their potential. Richard visited many of the families and communities of ex-orphanage children, it was quite devastating to witness the grinding poverty in which they found themselves and it quickly became evident that we cannot help everyone! In order to produce any significant benefit we had to choose a few. Such a difficult process came down to both need but also those children with which we have connection, have witnessed grow, and have photos of our daughter playing together with. Talking to the families and community members, spending time amongst them and visiting houses, seeing the local infrastructure, water, land, access etc allowed Richard to make decisions as to how best provide assistance. Initially three families and their communities will receive support for housing improvement and food, energy and water security, and other additional children will receive assistance with school materials. If successful in sustainable fund raising we will hope to expand this. Housing is often poor with leaking roofs, no sanitary toilet facilities and no covered cooking area. In the rainy season families go hungry. Many of the children (and adults) show signs of disease such as Pellagra, Beri-Beri and Kwashiorkor, directly due to protein, energy and vitamin malnutrition. Access to food security including the means to catch fish and land for agriculture is limited due to lack of investment ability, land ownership and in some areas population density. Primary education is free but difficult to access (1.5hrs walk), of poor quality and secondary education expensive and rarely can children go. There is plenty that a little will achieve short term. Housing improvements to roofs, adding kitchen lean-tos and toilets. Wood efficient stoves. Solar cooking was originally considered but is likely for cultural and time investment reasons not to be engaged with. Improved bedding areas with reduced person per mattress ratio. Providing small boats and fishing equipment, chickens and goats to improve protein availability and land acquisition/rental for agriculture. Water filters. In the longer term, once the basics of living are improved, scholarships for secondary education aiming for university and technical college qualifications. This will hopefully break the cycle of poverty and provide role models of individuals to further inspire the community. These children can be given the opportunity to have choices that may positively impact on their futures, aspire to have a life less ordinary and inspire others to follow. Funding for micro-projects to enable income sources and employment for the local economies and investment for sustainable resources to feed back into projects is a long term goal. We do not have all the answers and we are sure more questions will emerge. But to do nothing is not an option. We aim to provide some basics that we take for granted, but in a culturally, environmentally and technologically appropriate and sustainable way. A hungry child cannot learn -we aim to increased sustainable food security including supply of chickens, seeds to grow vegetables if land is available, or even a goat. A tired child cannot learn - we aim to provide mattresses and bed nets to improve sleep hygiene and protect against insect borne disease. Energy insecurity reduces the time available for learning - we aim to reduce the use of wood for cooking and kerosene for lighting. These can cost up to 40% of income and are time consuming to source. They pose significant health risks (estimated to be equivalent to smoking 40 cigarettes per day). Solar lamps may be an efficient way of allowing transfer of time and financial resources to education. Indoor cooking and wood efficient stoves improve fuel use. Costs:* Schooling - AS$760 per year One chicken - AS$10 One goat - AS$50 One mattress - AS$50 One bed net - AS$10 One solar lamp - AS$20 A new roof - AS$500 A covered kitchen - AS$500 *These costs are approximate and will depend upon transport costs and accessibility to each of the communities. We aim for this to be a long term project and eventually see these children return to the communities with qualifications and jobs to help their families and the future generations break the cycle of poverty. Please give what you feel you can, every little helps and consider becoming a regular donor. We will provide photo journal updates about improvements, acquisitions and the children's school progress. Thank you for reading.