"Everyday Miracles" by Karen-Schmidt of Miller-McCune.com

Forty-something years ago, when I was born in Pittsburgh, Pa., I was a sickly thing. I weighed only 6 pounds. I had a strep infection and wouldn't eat. The doctors put me in an incubator and treated the infection, and within a few weeks I was well enough to go home to my family's split-level in the suburbs.

A few years ago, a 9-year-old boy named Samson came down with strep. But he lived in rural Rwanda, not suburban Pittsburgh, and his family did not have the pennies needed to take him to the clinic to be treated. He developed rheumatic heart disease that damaged his heart valves, and for years he was too ill even to attend school.

After spending 10 years of my career in global health, five of them in Rwanda, I know the numbers. Samson is just one of hundreds of thousands of children in Africa whose minor illnesses go untreated every year. Worldwide, a child under 5 dies about every three seconds. Up to a third of those die within weeks of birth. The rest die primarily from pneumonia, measles, malaria and diarrhea — all preventable or treatable illnesses. It's an overwhelming tragedy, all the worse because it's avoidable. Rwanda's child mortality rate has shown remarkable improvement in recent years, but more than 10 percent of babies still don't make it to age 5.

How is it possible that in 2009, a baby just like me would likely not survive if she had the bad luck to be born somewhere like Rwanda? How can it be that even in the United States we have yet to put into practice the simple logic of making sure sick people get treatment so they don't get sicker?

Solid primary health care isn't really hard; in fact, it's kind of boring. Most ailments are routine. Many can be prevented. It's only when the little things don't get managed that things become — disgracefully — interesting.

Thirty years ago, the International Conference on Primary Health Care in Alma-Ata, in what was then the USSR, adopted the Declaration on Primary Health Care, a sweeping document that launched a movement to make primary health care "a fundamental human right." Last October, back in the same city — now known as Almaty, Kazakhstan — another international gathering marked the publication of a World Health Organization report titled "Primary Health Care: Now More than Ever." In her introduction to the report, WHO Director-General Margaret Chan acknowledged that "despite enormous progress in health globally," the failure to make primary health care essentially universal was "painfully obvious."

The classic indicators of health have certainly improved worldwide in the past three decades, but progress has been desperately uneven: Gaps between rich and poor have widened, and some of poorest countries have actually lost ground. Although the global under-5 mortality rate has been cut in half since 1970, the United Nations reports that 27 countries in the world, most of them in Africa, made no progress from 1990 to 2006 in reducing child death. In 1977, life expectancy at birth in sub-Saharan Africa was 48. By 2006 it had only risen to 50. Even in places that are better off overall, such as India and the United States, health disparities within countries remain stark. The American Cancer Society reported in December that African Americans are 48 percent more likely to die of colon cancer than white Americans. The Institute of Medicine estimated that 18,000 people died in the United States in 2000 because they didn't have health insurance; an update a year ago by the Urban Institute reported that the figure has risen steadily, reaching 22,000 a year in 2006.

It doesn't have to be this way. Whether the solution for preventing serious disease is cancer screening, the prompt treatment of malaria, blood pressure pills or a measles shot, the most logical place to provide it is through a functioning system of primary health care that is accessible - geographically and financially — to everyone. Over the years, policy wonks have defined primary health care in many ways and rebaptized it many times: It's been called close-to-client care, patient-centered care and, more recently, medical home. At the simplest level, though, commitment to primary health care is as an approach that starts with preventing and treating the easy stuff and only gets more sophisticated when the patient needs it.

Where Samson lives, in Rwanda's Bugesera district, the clinic was barely functioning a few years ago. Mayange Health Center had a solid building but no power, almost no medicine and an unmotivated, poorly compensated staff. The center saw only a few patients a day, and every month almost all the expectant mothers in the area delivered at home rather than pay the cost of delivery at the sparsely equipped maternity room. Throughout the country, health centers were called death centers.

Read the whole article here.

"Kubaka" -- by Reynolds Whalen

During my time in Rwanda, I have had the pleasure of connecting with the organization of my roommates Amir and Anna, called "Miracle Corners of the World " (MCW). This is an international network that empowers youth to become positive agents of change, to improve their lives and contribute to their communities. MCW serves youth through leadership training, community development, oral healthcare, and partner initiative programs.

In Rwanda, MCW has begun building a community center inspired by the ideas of youth throughout the Bugesera District, several kilometers south of the capital city of Kigali. This center will house an ICT center for learning computer skills, a classroom for language instruction, and a preschool, among other facilities.

This project will be particularly important in facilitating Rwanda's switch from Francophone to Anglophone, which occurred officially only several weeks ago at the end of 2008. In fact, Miracle Corners Rwanda hopes to build the first public library in the entire country, focusing on making English-language books available to the community.

"Kubaka" in Kinyarwanda means "Construction." This film tells the story of the groundbreaking ceremony for the center, highlighting some of the ways MCW has been working with the community, and celebrating the opportunities for education, networking, and socialization that have been and will be "constructed."

My life in Nyamata has also offered me many opportunities for personal "construction" and reflection on life's deepest joys.

The other day, in desperate need of exercise, I ran up one of Rwanda's "thousand hills" after work. At the top, I enjoyed a dazzling view of Nyamata and the surrounding villages. Coupled with the sound of my own heavy breathing was the never-ending chorus of children squealing in glee or utter dismay (i've remembered recently that kids rarely fall anywhere on the spectrum of emotions except the absolute extremes).

Later that night, I found myself interrupted at my computer by my landlord Bosco, who showed up at my door with his larger than life, tooth-missing smile, insisting that I join him and his wife for dinner. Moments later, I found myself at table with the two of them and Amir, laughing our way into the African night and struggling joyously through our language barriers, elated to discover in the immense confusion an almost sacred bond of friendship that truly united our common humanity and reaffirmed my strong belief in Christianity, a religion focused on the two qualities that made the night transformative: love and community."

Part I



Part II



Reynolds Whalen is living in Rwanda working for Millennium Congregation, linking congregations with the work of Millennium Villages Project in that nation. His work is chronicling the work going on there and he will be posting regular videos to this blog.

"The Millennium Village Project--Mayange Drought" -- Reynolds Whalen

Reynolds Whalen is living in Rwanda working for Millennium Congregation, linking congregations with the work of Millennium Villages Project in that nation. His work is chronicling the work going on there and he will be posting regular videos to this blog. Here's his first, about the drought in Mayange, Rwanda and the work of the Millennium Villages Project to address it.

“Millennium Villages in Rwanda are turning the page on poverty” by The Rev. Jay Lawlor

When most people think of Rwanda they recall the tragic genocide of 1994. The genocide should never be forgotten and we must always be looking to how we can foster greater justice, compassion, and reconciliation in our world so such tragedies can be avoided. Nonetheless, Rwanda has spent the past 14 years journeying from the genocide to become a nation of reconciliation and one deeply committed to eradicating poverty. Rwanda's President Kagame and its Parliament have made significant commitments toward achieving the Millennium Development Goals. A critical component of Rwanda's MDG strategy is their partnership with the Millennium Villages Project.

The Millennium Villages Project was founded by Professor Jeffrey Sachs and his team at the Earth Institute at Columbia University and is managed by the Earth Institute and the Millennium Promise Alliance (Millennium Promise). The Millennium Villages Project is based on a single powerful idea: impoverished villages can transform themselves and meet the Millennium Development Goals if they are empowered with proven, powerful, practical technologies. Millennium Villages offers a comprehensive and holistic approach to ending extreme poverty as they explicitly address all eight of the MDGs in every village. By investing in health, food production, education, access to clean water, micro-enterprise, and essential infrastructure, these community-led interventions are enabling impoverished villages to escape extreme poverty once and for all.

Rather than a “hand-out,” Millennium Villages are a “hand-up.” Once these communities get a foothold on the bottom rung of the development ladder they are equipped to propel themselves on a path of self-sustaining economic growth.

In November 2008, the Overseas Development Institute (ODI), a leading British think-tank, released the results of an independent review of the Millennium Villages project (the full report is available on ODI's website) In its report, the ODI states that the MVP has achieved “remarkable results” and has “demonstrated the impact of greater investment in evidence-based, low-cost interventions at the village level to make progress toward the Millennium Development Goals.” In response to the report, the Financial Times declared on its front page “Village project thrives.”

Also in the news, on November 11, 2008 the New York Times ran an article about Millennium Promise in its special giving section. In highlighting the Millennium Villages’ work to end extreme poverty, the article opens by saying, “Even amid widespread angst over withered portfolios and a rocky economy, some Americans remain committed to helping the poorest of the poor.” In the article, one of the projects most visionary supporters, George Soros, says about the MVP, “It can be a model for bringing about systemic change,” and “if it can be scaled up, it will make a very big difference.”

A shining example of this amazing project is the Millennium Village in Rwanda, headed by Dr. Josh Ruxin. The Millennium Village cluster in Rwanda is located in Mayange, a sector of Bugesera District located about 25 miles south of the capital city of Kigali. In a country known as the “pays des milles collines” (“land of 1,000 hills”), the terrain around Mayange is flatter and drier than most of Rwanda. The area suffers from sporadic rainfall and declining soil fertility, leading to endemic poverty, illness, and a lack of economic opportunity. The project began working with an initial 5,000 people in Kagenge, one of Mayange's five subdivisions, or cells as they are referred to in Rwanda, in early 2006. The population was facing impending famine because of failing rains and a poor harvest the year before, and the health center was severely lacking in staff, medicines, equipment, and supplies, and had no electricity or running water. Today, the Millennium Village in Rwanda is turning the page on poverty.

By applying targeted, science-based interventions and maximizing community leadership and participation, the villagers of Mayange went from chronic hunger to a bumper harvest in 2006. Malaria incidence has been almost eliminated, the health clinic is booming with patients who know they'll receive good care and treatment, and children now have electricity and a computer lab at school. In under three years, Mayange is being transformed. PBS' FronlineWorld has produced a segment on the MVP's success in Rwanda (watch the rough cut online here).

It is because the Millennium Village model is proving so successful in achieving all eight of the Millennium Development Goals that I have founded Millennium Congregations to help communities of faith learn about, advocate for, and partner with Millennium Villages in Rwanda. The excitement and interest around Millennium Congregations' work with Millennium Villages is building. As you may have read in his recent blog entry, Reynolds Whalen arrived in Rwanda this past December to document the stories of the people in the Millennium Village for Millennium Congregations. The videos will become powerful witnesses of all that is being achieved and all that is possible. The good work of Millennium Villages in Rwanda offers communities of faith a very practical, proven, and concrete way to develop partnerships in achieving the Millennium Development Goals. Please visit the Millennium Congregations website to learn more and sign-up for news on how you and your congregation can support our work and partner with the Millennium Villages Project in Rwanda.
The Rev. Jay Lawlor is a priest and economist. He has worked with Jeffery Sachs and the Earth Institute on the MDGs and is currently living in North Carolina and founding an interfaith nonprofit aimed at getting faith communities involved in the Millennium Villages Project.

Two Videos from Rwanda to Make Your Heart Glad! -- by Reynolds Whalen

Reynolds Whalen, who blogs here regularly, has just arrived in Rwanda where he will be living and working for six months for Millennium Congregation -- a wonderful new nonprofit that is linking congregations of all faiths with "Millennium Villages" that are making the MDGs happen in Rwanda.

Reynolds will be shooting lots of video and doing lots of other things to tell the story of the amazing ministry happening in Rwanda (for a snapshot of all the projects he has lined up, check out the latest post on his blog). As a test of his video equipment, he shot these videos at the groundbreaking ceremony for a site for Miracle Corners of the World (MCW), a non-profit promoting local change and global exchange, a community driven process. The site that will include a preschool, a radio station for Bugesera District, and other educational and gender empowering initiatives.

This first clip is of a group of youth dancing.



This second clip is of kids marveling at Reynolds' LCD screen, which is reversible and can reveal the live video to the subjects. Kids love seeing themselves on live video.



These faces are the face of Christ, the image of God. Watch and enjoy!

"One Word: Plastics" -- by Reynolds Whalen

I got off a plane in Kigali yesterday after a trip that took 35 hours including layovers. Driving through the city, one of the first things I noticed was the remarkable lack of trash. I believe this can be largely attributed to the Rwandan government's decision to ban plastic bags from the country.

In many parts of nearby Kenya, especially informal settlements and slums, one of the most striking images is streets lined with plastic bags, strewn across roads like carpets whose designs are the art of the nation's waste. Now, Kenya too has banned plastic bags.

Several weeks ago, I watched an independent documentary about an area the size of Texas in the Pacific Ocean known as the "Great Pacific Garbage Patch." Here, plastic floats freely and collects in large, ice berg-type chunks the size of a small car. Gutting a fish or an albatross reveals stomachs lined with plastic bags, wrappers, cellophane, and bits of plastic jugs. The biggest problem, however, is more subtle. Because plastic is non biodegradable, it breaks down smaller and smaller, literally changing the composition of the sea water and poisoning everything with which it has contact.

Perhaps our country too should consider banning plastic in as many forms as possible and using our political clout to encourage others to do the same. As with many issues I have noticed and studied, perhaps we should focus less on what we have to teach Africa and more on what Africa has to teach us.

"Rwanda's Women are Leading the Way" -- by Cindy McCain

Cindy McCain wrote this op-ed for yesterday's edition of the Wall Street Journal about her travels in Rwanda and the living example she found of the critical nature of women's empowerment.

I have recently returned from Rwanda. I was last there in 1994, at the height of the genocide that claimed the lives of more than 800,000 Rwandans. The memories of what I saw haunt me still.

I wasn't sure what to expect all these years later, but I found a country that has found in its deep scars the will to move on and rebuild a civil society. And the renaissance is being led by women.

Women are at the forefront of the physical, emotional and spiritual healing that is moving Rwandan society forward. One of them, from eastern Rwanda, told me her story -- a violent, tragic and heartbreaking testimony of courage. She spoke of surviving multiple gang rapes, running at night in fear of losing her life, going days without food or water and witnessing the death of her entire family -- one person at a time, before her eyes.

The injuries she sustained left her unable to bear children. Illness, isolation and an utter lack of hope left her in abject despair.

And yet the day I met her, she wasn't consumed by hatred or resentment. She sat, talking with me and a few others, beside a man who had killed people guilty of nothing more than seeking shelter in a church. She forgave him. She forgave the perpetrators of her tragedy, and she explained her story with hope that such cruelty would never be repeated.

It is a humbling experience to be in the presence of those who have such a capacity for forgiveness and care. It is also instructive. If wealthy nations want their assistance programs to be effective, they should look to the women who form the backbone of every society. With some education, training, basic rights and empowerment, women will transform a society -- and the world.

Women today make up a disproportionate percentage of the Rwandan population. In the aftermath of the genocide, they had to head households bereft of fathers. They had to take over farms, and take jobs previously done by men. But there were opportunities, too: Today, 41% of Rwandan businesses are owned by women.

I saw their impact first hand at a coffee project in the city of Nyandungu. All the washing and coffee-bean selection is done by hand, by women there. Women to Women International, a remarkably active and innovative nongovernmental organization, has already helped over 15,000 Rwandan women through a year-long program of direct aid, job-skills training and education.

The organization is launching a project to train 3,000 women in organic agriculture, and is reaching out to females across the country. The women who instruct their fellow war survivors in economic development are an inspiration to those who cherish the essential benevolence of humanity.

But that is just the beginning. A new constitution ratified in 2003 required that women occupy at least 30% of the seats in parliament. (In our House and Senate only about 17% of the seats are filled by women.) Some wondered at the time whether it was feasible to meet this target. Now, nearly half of parliament and a third of the president's cabinet posts are held by women. Rwanda today has the world's highest percentage of female legislators.

Rwanda has a dark past but a bright future. It has a long way to go -- the country remains one of the world's poorest, and the social reverberations of the genocide are evident everywhere. Yet in the midst of tragedy, the women are building something genuinely new. Perhaps it is fitting that a nation so wracked by death could give birth to a vibrant new age. I know that one thing is clear: Through their bold and courageous actions, these women should inspire not only their fellow Africans, but all individuals -- men and women -- across the globe.

Mrs. McCain, the wife of Sen. John McCain and mother of four, founded the American Voluntary Medical Team, which helps bring doctors to war-torn countries.

"Hannah Ministry -- Bringing hope to child-led families in Rwanda" -- by Josephine Mujawiyera

The densely populated area of Northern Rwanda around the provincial centre, Byumba, has a high concentration of orphaned children. The Byumba area suffered four years of war leading up to and including the 1994 genocide. During this period, many widows were raped, a high proportion died after contracting HIV/AIDS, leaving orphaned children, many of whom themselves infected with HIV/AIDS. Since the genocide, many parents have died from HIV/AIDS or other causes, creating many more orphans.

In the past, help came traditionally from the extended family, but following the displacement of whole communities, the dislocation of families and the extreme poverty which followed the genocide and its aftermath, extended families have generally been unwilling to take on the additional burden of accepting orphaned children under their own roofs, limiting their involvement to supervision, hoping that others (often international aid agencies) would take responsibility for them.

The Anglican diocese of Byumba has had a particular ministry for widows and orphans since the genocide. From the beginning, their emphasis has been on providing psychological and practical support to widows and orphaned children within their own home environment. This approach is now being widely supported by the aid agencies, NGOs and the Rwandan government, who all recognise the advantages of enabling children to become self-supporting in the environment they know.

Nevertheless, until recently, few coordinated programmes have been established to adopt such an approach in a holistic manner.

Hannah Ministry, an autonomous organisation under the umbrella of the diocese of Byumba, has put in place structures and practical support (largely drawing upon the volunteers within the distributed parishes across the area) aimed at fully equipping orphaned children for an independent future within a family unit made up of their own siblings.

The child-headed family support programme takes its inspiration from the Kinyarwanda word, 'tumurere' embedded in Rwanda culture -'let us combine our efforts to care and bring up children'.

Among the many things Hannah Ministry provides is a sponsorship programme to support child-led households. With a gift of just $20, a month a child will get education, food, shelter, manpower on a child field, health care counseling and close follow up on his state.

For more detailed information about the many programmes of Hannah Ministry and information about sponsorship, download the Hannah Ministry Report from the EGR website or on the Friends of Byumba website (www.friendsofbyumbaorg).

Who are these child-led households. Here are but two of many examples.

This is a typical housing for a child who did not get any sponsorship and subsequently can't repair the house by himself. These two children live in a house left by their parents when they died.

Here is a picture Seraphine with her siblings taken at their home. There is need for proper sharing for a child-led household to get support. How many times do they go to bed without supper?

Sponsors are encouraged to pray for the families and for the Hannah Ministry and its important work, and to encourage friends and other family members to become sponsors. All details can be found on the website or obtained from me by email at jomuja@yahoo.fr.

(Editor's note -- I have been to Byumba and seen firsthand the work Josephine and many others are doing with Hannah Ministry. It is an excellent example of the Church living out Christ's call to seek and serve him in the most vulnerable of the world ... everything that EGR is about. Josephine's tireless, passionate and creative work with Hannah Ministry is why I asked her to blog for EGR. For a further testimonial about Hannah Ministry, contact the Rev. Amy Real Coultas, Episcopal campus minister at the University of Lousiville, who has been working closely with Josephine in supporting this ministry. Find out more -- and how to donate through Amy's church at -- www.helpinghannah.blogspot.com)

Josephine Mujawiyera runs "Hannah Ministries," a Christian organization in Byumba, Rwanda working with at-risk children (orphans, children infected and affected by HIV/AIDS, children living in a child led household, and street children). It is a local initiave born to respond to the needs of children living in child-led households.works with people living with HIV/AIDS. Jospehine also does general post-genocide reconciliation work (among MANY other things) in Byumba, where she lives with her husband, who is bishop of that diocese.

"Millennium Congregation -- What One Person Can Do" -- by Reynolds Whalen

Let me tell you about a new non-profit called Millennium Congregation. I’ll start with a quote…

“If you want to eradicate poverty and promote justice, compassion and reconciliation, then I invite and encourage you and your congregation to join Millennium Congregation's exciting initiative in support of Millennium Villages."

+ Archbishop Desmond M. Tutu

Most of us know the statistics by now surrounding the horrors of extreme poverty. We live in a world where a child dies every three seconds from a preventable illness, where half a million women die every year in childbirth, and where 110 million children do not even have the opportunity to learn how to read the books that tell them about the 1.2 billion people worldwide living on less than $1.00 a day. For people of faith who believe in global justice and enacting God’s love through our very own lives, these numbers should excite and invigorate us.

Yes, you read that correctly.

Certainly, these figures can be daunting and depressing. But they also represent an incredible opportunity. The entire premise of drafting the Millennium Development Goals (MDGs) was this: for the first time in human existence, we have the ability to eradicate extreme global poverty.

It’s time to stop wallowing in the figures, using their enormity as an excuse for inaction. We must stop focusing on the statistics when educating our congregations about the MDGs and start focusing on the amazing things we can do to change them. This is what people like Dr. Josh Ruxin and the Rev. Jay Lawlor are doing.

For the past couple of years, Josh has been living in Rwanda and implementing the Millennium Villages Project (MV). In an era where “development” and “aid” have become a fad and far too many programs serve their own interests before the communities they seek to improve, MV is a shining beacon of light. This is one of the few development projects using a comprehensive approach by addressing all eight MDGs at once, and at the level of an entire village. Rather than building a house for one family or installing a water pump for one neighborhood and creating dependence on those who installed it, MV equips entire villages with a self-sustaining system of productive growth. To read more about their incredible work and success, go here. This is one of the most amazing and effective development projects in the world, but it is not cheap.

Here is where you and I come in.

Several months ago, the Rev. Jay Lawlor launched an initiative to support MV called Millennium Congregation (MC). This non-profit operates on the principle that extreme global poverty is an issue on which all faiths can unite and have a significant impact. By pledging as little as $50 a month, your congregation can join other communities of faith in changing the course of human history.

Soon, I will be traveling to Rwanda to film, interview, and document Millennium Village’s story, putting stories and faces on the incredible people Millennium Congregation seeks to support. We also hope to establish more internet communication, including blogs and international video web-chat. Most importantly, MC plans to offer members of congregations the chance of traveling to the villages themselves. All of these initiatives will provide you and your congregation with the personal connection you need to warrant a financial and personal commitment. Now, your 0.7% (or more!) can support a comprehensive and effective development program in which you can build relationships and see the direct impact of your contribution.

The time has come for us as people of faith, and as caring human beings, to take the next step in eradicating extreme poverty by joining forces and doing something really big. Millennium Congregation simply provides the networks and the tools. It’s up to us to pick them up and use them.

Reynolds Whalen is a 2008 graduate of Washington University in St. Louis and has traveled extensively in Kenya, Uganda, and Sudan. He spent fall semester 2006 in Kenya working with AIDS orphans -- read his blog on it here and has made a documentary film on that experience. He is currently raising funds to spend 2008-9 working in Rwanda for Millennium Congregation helping people in the villages of Rwanda tell their stories. You can give toward Reynolds work in Rwanda with Millennium Congregation here (be sure and put Millennium Congregation - Reynolds Whalen in the designation field)

"Doctors Without Orders" -- by Dr. Josh Ruxin

To improve global health, what we need isn’t just Bill Gates’ billions, but Microsoft's managers.

Two years ago, I saw a line of 30 people waiting for services at Nyamata Hospital in Bugesera, a rural region in southern Rwanda. Its approximately 300,000 residents live clustered around small villages. It was the epicenter of the 1994 genocide and remains one of the poorest districts in the nation.

The hospital is on a charming plot of land, and its infrastructure is welcoming, impressive, and modern. It has some 60 professional staff and half a dozen doctors, an adequate number of personnel for a district facility. But while a line of 30 people seems long to Americans, it’s not to Rwandans. I was surprised to find so few lined up for the sort of high-quality care that this hospital promised, on the surface, to deliver.

When my team asked why so few patients were there, the staff, the patients, and the community all pointed to the same cause: a malfeasant and incompetent director. "People go to that hospital to die because the director doesn’t care," they told us. Apparently, his attitude and style was such that it seeped into the rest of the staff. No one else cared either, even with state-of-the-art equipment and new facilities.

I wasn’t fully convinced of how poisonous the culture had become until two incidents a few weeks later. A nurse, who worked for one of my projects and volunteered at the hospital, told me she was appalled by the shoddy and rancid-smelling mattresses in the patient rooms. After pushing the issue with the staff, she learned that brand-new mattresses had been in a storage room awaiting use for years. Soon after, I bumped into an extremely poor woman who had recently had an emergency caesarean delivery at the hospital. When I asked her when she was returning home, she explained that she had been ready for four days, but that the hospital director insisted on her paying for the ambulance to travel the 30 kilometers to her home. The price demanded was higher than her monthly income, and no one at the hospital seemed willing to figure out how to resolve the dilemma.

Not surprisingly, performance and opinions changed rapidly when a new director arrived. This new manager cleaned up the hospital’s accounting, queried staff on major management and resource needs, fired incompetent and corrupt employees, and figured out how to respond in a timely, thoughtful manner to key challenges. Within two months, there were working X-ray machines for the first time in two years. Staff morale improved dramatically. Today the hospital sees more than 100 patients a day, and the community views it as a center for healing, not dying.

The lesson? In public health, just as in any other collective endeavor, management matters. It seems like an obvious point, and yet at the heart of some of the world’s worst public health crisis zones, it is one that has yet to sink in–with dire consequences for millions.

The history of public health in the twentieth century can be characterized as a losing battle for resources against a rising tide of epidemics and pandemics. In spite of some breakthrough solutions to massive problems like childhood disease and pandemics like polio, the failure to construct viable public health systems in the developing world has helped create the conditions for the pandemics of today: tuberculosis, AIDS, and cardiovascular disease, among many others. To make things worse, massive health problems predating these remain, from extraordinarily high maternal mortality rates to the scourge of malaria. The numbers are so breathtaking that they obscure the heartbreaking stories each represents. Globally, there are still an estimated 500 million episodes of malaria every year that claim at least one million lives, and in Africa more than 250,000 women die in childbirth annually. Over the past two decades, these grim statistics have scarcely budged, and in many countries, they have worsened.

If public health planners were business people objectively examining the sector’s progress today–particularly in sub-Saharan Africa, where average life expectancy is now 46 years, versus 67 in the rest of the world–the answer would clearly point to a change of strategy. Many international public health programs are so poorly run–or at least achieve such poor results–that they resemble the management quality of a local lemonade stand rather than an Apple or Google.

It’s not that public health workers don’t have their hearts in their work. It’s that the global public health workforce has long had to make do with small initiatives that were perpetually under-funded and training that valued a flair for squeezing results out of miniscule funding. However, we live in an age when immense public and private resources are suddenly available. From major programs like the Global Fund to Fight AIDS, Tuberculosis and Malaria to bilateral ones like the U.S. President’s Emergency Plan for AIDS Relief, along with major efforts led by nonprofits like the Bill and Melinda Gates Foundation, global public health is now discussed for the first time in history as a venture warranting and receiving billions.

With so much money being committed and so many lives at stake, it’s time to revolutionize global public health. We need less do-goodism, and more do-it-rightism; we need more managers, not more doctors. The billions of dollars in new funds must propel an infusion of new management talent and practices based on private sector experience. We must upgrade the entire health system in countries–and in poor countries with few doctors, that means taking medical doctors out of management positions and replacing them with professional managers. It means encouraging nongovernmental organizations (NGOs) to cast their nets wider when recruiting public health workers in order to pull leaders from the private sector rather than the public sector, and teaching the management of health delivery to soon-to-be minted public health graduates. And it means building new initiatives like we would a business, with rational accounting and delivery systems, while likewise reforming existing efforts.

This is not a popular position; it is, to be blunt, easier to treat the disease than the cause. For instance, programs for childhood health and family planning, which could revolutionize African public health, have been dwarfed by spending on HIV/AIDS, in spite of the far greater complexity and cost of rolling out such programs. This is not to argue that we should return to the days of limiting interventions based on appallingly small public resources: On the contrary, to fight AIDS effectively, improve maternal and child health, and meet all the other deep-seated public health challenges, we must build out health systems in poor countries. But relying on traditional public health workers will fail. It’s time to shake up the public health establishment and do nothing less than completely reinvent it.

Click here to download the entire article. Or read it online here at DemocracyJournal.org.

Josh Ruxin is a Columbia University expert on public health who has spent the last couple of years living in Rwanda, where he administers the Millennium Villages Project in Mayange. He’s an unusual mix of academic expert and mud-between-the-toes aid worker. His regular posts can be found on the blogroll of Nick Kristof of the New York Times, and he has given his permission to be cross-posted here. Josh and EGR executive director Mike Kinman team-teach a global poverty module for Trinity, Wall Street's Clergy Leadership Project.

"Germany, Congo, Darfur, Rwanda" -- by Dr. Josh Ruxin

April 7, 2008, was the 14th anniversary of the commencement of Rwanda’s genocide. With periodic massacres that date back to 1959, Rwanda’s genocide did not happen overnight. Its climax, however, began April 7, 1994. It was a few days later that 36-year-old Epafrodite Rugengamanzi was murdered. From what his sister, Josepha, has gathered, he was chased into the yard of the house where we now live, brutally killed, and buried. Her brother’s killer confessed to the murder during gacaca — the traditional court process for genocide suspects — and brought her to his burial spot.

The disinterment of Epafrodite Rugengamanzi

Josepha came to our house Wednesday with other family members and dug up her brother’s skeleton. The orchestrated process took several hours. Once they were sure that all of his bones had been collected, they carefully cleaned them. Josepha then asked me and my family to come over and listen to their testimony (and asked us to share it with others). Josepha was smiling and told us how lucky she felt to have found her brother’s bones and to be able to re-bury them shortly at Gisozi, the national genocide museum and burial ground.

Epafrodite Rugengamanzi

Josh Ruxin with Josepha

Epafrodite’s murder was avoidable, since the UN had the power to prevent it. Ultimately it was not an international team of peacekeepers who brought Rwanda’s genocide to a close, but rather, the Rwanda Patriotic Army, a disciplined military force drawn from Rwanda’s diaspora. After years of fighting, the Rwanda Patriotic Army on July 4, 1994, brought stability to the country. Human Rights Watch, a French judge, and a Spanish judge allege, however, that the Rwanda Patriotic Army carried out thousands of reprisal killings and crimes against humanity during and after the genocide. President Kagame publicly bristled this past week over the recent Spanish indictment.

A close look at the complexities of Rwanda’s genocide would remind China’s leader Hu Jintao, President Bush and others of the path history can take, yet does not have to. Darfur is at least beginning to take on some of the dimensions of Rwanda: a gradual genocide in a region still lacking an adequate peacekeeping force and the political commitment to bring it to an end. The carnage there continues and now a new genocide threatens in Southern Sudan. While hope has so far proven elusive for Sudan, it is even harder to imagine that its people will get themselves on Rwanda’s track to peace and prosperity anytime in the next few decades. Rwanda’s resilience and approach are exceptional.

My friend and head of Orphans of Rwanda, Jean Baptiste Ntakirutimana, wrote me the other day about his meeting last week with his mother’s killer: “I inquired first about his life in prison, his family and his state of mind. He said he was expecting that I could kill him, which he thinks was the way of doing justice for having killed my mum. He added that no one dared killing my mum; that she was brought by two militia to her home village and called for people to come and kill her. No one did so besides him who felt he had to kill her. In fact he told us that they were told that no one was allowed to loot from Tutsis before killing all their family members. Since they thought I was already killed from Kigali, where I was residing, the only hindrance to take all the family property was my mum. So she had to be killed. By the time he started explaining how he killed her I partly lost consciousness. I prayed to God to give me His spirit to revive me and give me more strength to continue, as I felt it was His mission I was on. Miraculously I felt warmth from my head to my feet, I felt like a big rock melting from my chest and my head. I felt very refreshed, cleaned up my tears and carried on the conversation tremendously relieved from my whole being. I then told him that I have personally been forgiven all my wrong from God and that it is in the same spirit that I was coming to him offering him pardon myself. Then it was like a huge veil off his face he started smiling with a lot of words of gratitude. He started holding my hands and telling me many other things I couldn’t expect about himself and the reality around the genocide. He agreed to go and see other people for whose family members he killed.”

Fourteen years later, Rwandans are still struggling to reconcile the past. The struggle, however, is proving easier against a backdrop of national stability, economic growth, and a rising national profile. Foreign investment is at a high, there are swank hotels, and tourists are coming by the thousands.

Post-genocide history is mired in enduring civil conflict and instability. Rwandans know firsthand that exports such as peace and stability are far superior to tales of disaster, massacres, and corruption. Rather than provide the object lesson of what can go wrong, Rwanda now embodies quite a different ideal. The nation was one of the first to send peacekeepers to Darfur and today has one of the largest contingents on the ground. Nothing points more clearly to Rwanda’s recovery and resolve.

Josh Ruxin is a Columbia University expert on public health who has spent the last couple of years living in Rwanda, where he administers the Millennium Villages Project in Mayange. He’s an unusual mix of academic expert and mud-between-the-toes aid worker. His regular posts (including this one) can be found on the blogroll of Nick Kristof of the New York Times, and he has given his permission to be cross-posted here. Josh and EGR executive director Mike Kinman team-teach a global poverty module for Trinity, Wall Street's Clergy Leadership Project.

"Love the whole world, one person at a time" -- by the Rev. Becca Stevens.

I have been thinking about what it means to love the world. A group of seven women from the Magdalene Community just returned home safe and sound from Rwanda. It was amazing, and we thankful to be with our families again. The women we met fell in love with the message and community of Magdalene. We read letters the women from Nashville sent and in response, the women who are part of the sisters of Rwanda started sharing their experiences of surviving incest, violence, addiction and prostitution. Their staff said that they had never heard the women talk so openly. In gratitude and solidarity with the women of Magdalene, the sisters of Rwanda wrote letters and sent video messages to us. The stories are hauntingly similar.

Rwanda is full of people walking around with ghosts, while new life is strapped to the backs of women. Hearty crops are blooming next to people so poor they can't feed their children. It was so much to take in sometimes my legs would shake or my head would throb. Our small group carried you all with us the whole time. It was the right trip and we all think there are many more villages of women who want us to be with them. We found the cousins to the thistles. One of the many lessons I learned in Rwanda was that rape and love are universal actions. Neither get lost in translation and our job is to love the whole world, one person at a time.

Seeing women in traditional African dress with goggles and rubber gloves preparing to make soap is awesome. They were so excited when we started the second morning, they had already started cleaning the equipment. We went to villages where women waited all day to see us. They were stunning, poised, and almost whispered what they needed to tell us about their lives and their need for hope and money to keep going. We went to the market and purchased shovels, seeds, and sewing machines in response to some of their requests. Sometimes its just a fishing pole people need. They already know how to fish. The faith we saw was inspiring and a little intimidating. The singing and dancing were beautiful. The landscape is hilly with mists that come in like sweet blankets. It is strange to think of a million people dying on that land. It is hard to love the world, but if we can't, nothing else means anything to me.

"The Moral Issue of Suffering - The Gospel of John" -- by the Rev. Becca Stevens

John’s Gospel message this morning really begins while Jesus is walking with his disciple down the road after people threw stones at him in the Temple. Rejected from the flock, they meet a blind man. Jesus stops, even though it is the Sabbath, and makes an ointment from his spit mixed with mud and places it over the man’s eyes and he is healed. The religious authorities then question the man and throw him out as well. This is Jesus’ response and he says there is a gatekeeper who knows who the real shepherds are. It invites the listener to move beyond doctrinal issues that separate flocks and declares the gatekeeper is concerned about a higher imperative which is the moral issue to care for the suffering sheep, wherever they are and whose ever they are. That is the only way sheep are safe, and the voice of God is recognized.

On the eve of our journey to Rwanda by eight women from the community of Magdalene and Thistle Farms this Gospel is indeed good news. This journey allows us to care for women who are suffering: women trying to find sanctuary and freedom after surviving lives of violence, addiction, and prostitution. Their suffering has been and continues to be a moral issue because they are our sisters. That morality is not confined to people who share our doctrinal beliefs, it is not bound by nation/state boarders, and it affects people of all races and ages. It affects all our communities, the culture we live in, the health of the world, and how we raise our children.

Last week, one of the residents of Magdalene, our community dedicated to women who have suffered similar trauma here in the United States, spoke to the student body of Vanderbilt Law School about her experience of being the only teenager to ever testify in a federal case against a huge child prostitution and pornography ring. She talked about what a long journey it has been so far and about the guilt and fear she faced in naming the men who abused her. She talked some about coming to terms with being a child of God and dreaming of a future and helping others. For her, the dreaming includes finishing school and going to college and ministering to others who have suffered. One of the Law students raised her hand and asked, “Where do you want to go to school”. She held the mike and said, “Maybe here”. Those thin lines that some of us still draw in spite of our selves to separate flocks were erased with surgical precision in her words. “Maybe here.”

Eleven years ago when Magdalene was created we wrote that we wanted to be a testimony to the truth that in the end love is more powerful then all the forces that drive women to the streets. Those streets are hell, I have been told, and I haven’t met a woman who hasn’t been raped and who isn’t destitute. The Gospel says such suffering should cause us all to stop and make mud ointments to soothe the pain, even if we are at a place in our lives where we feel a little out of the fold ourselves. Over 115 women have graced the threshold of the Magdalene community as residents and a thousand more have come as seekers to help and find healing. Seventy-two percent of the residents have graduated and I am so thankful to still get to be a part of such a flock. In that sheepfold people share the role of shepherding, we get to talk about the freedom of forgiveness we have known, how mercy runs deeper than abuse, and about how we have to learn to love without judgment each day.

A month ago Katrina Davidson, Susan Sluser, and I drove to Tuscaloosa, AL to preach, teach and sell our natural bath and body care products to an Episcopal Church. They welcomed us through their gate. We shared stories, talked about ministry, hugged as friends and even laughed about bath and body care products being the revolutionary tool we use to talk about women’s freedom.

Driving back I thought about the other churches in places like Indiana, Kansas, North Carolina, Chicago and New York that have already invited us to come and share our story this year. During the drive back we talked about how it felt like we were a new kind of missionary. Not in the sense that we have a new message, the message is as old as the gatekeeper, but in how we are not going out to convert people to a particular fold, but just trying to reach out to women who are suffering with a balm of Gilead and then go into churches to remind them that the moral issue of suffering is the matter of faith to confront. Dorothy Day, a beloved saint, says that you cannot help a sister or brother in need without getting naked first. The moral issue of the suffering of another requires us to look at our own suffering and remember all those who mixed their spit with mud to help us sit in this sanctuary today. All humanity knows suffering. The special gift of this fold has been to witness how love works in the lives of some of the most vulnerable voices in the world and hear their call as shepherds.

So we get to go to Rwanda and make candles and soap and hear stories of suffering on a colossal scale. In saying that we are coming, good things are already happening. The Serena hotel chain in Rwanda and Tanzania has sent us swatches so that they can order candles and soaps for all their rooms. A fundraiser by Bono’s group in July in Europe has ordered five hundred candles for their cause; a church in a remote village has invited us to preach on Sunday, the minister of gender and the embassy want to help. Before we step foot on the plane we are learning that we should never doubt that our compassion, our fire for justice, and our moral outrage, is needed and welcomed in a world with so much suffering.

This community is my sheepfold. It is where I was allowed in the gate stumbling always through what it means to be a shepherd. I have learned so much from so many here who have shepherded me. This has been the wandering flock where many of us have found sanctuary to grieve and freedom to grow in our faith. This Gospel invites us all to step through the gate again and care about the whole world and weep unapologetically for the suffering and our own blindness. This Gospel reminds us no one is outside the gatekeeper’s flock because he spent his entire ministry caring for the suffering of others on the way to offer his life for the sake of love. For that same loves sake, we are given the gift of caring for God’s sheep. Amen.

The Rev. Becca Stevens is a priest, author, rector of St. Augustine's Church in Nashville, TN and founder of Magdalene House. She has worked with her parish to found a school in Ecuador. Read her bio here.

“What Your Congregation Can Do to End Extreme Poverty” - by the Rev. Jay Lawlor

Next Monday (April 7, 2008), Millennium Congregation (formerly advertised as the Millennium Villages Faithful Action Initiative) will officially begin connecting congregations throughout the United States in partnership with Millennium Villages. Our initial goal is to fund five villages in the Mayange region of Rwanda and then continue to increase our support as part of Rwanda’s national scale-up of Millennium Villages across the nation -- helping Rwanda become the first “Millennium Nation” in achieving the MDGs and building sustainable village economies nationally.

The concept for Millennium Congregation is simple: 50 congregations - giving $500 a month- for five years - to empower 5,000 people to lift themselves out of extreme poverty and build self-sustaining lives for themselves and future generations. Each group of 50 congregations will support one Millennium Village in delivering practical and proven interventions in agriculture, health, education, and infrastructure that comprehensively address all eight of the MDGs by tackling the root causes of extreme poverty.

Millennium Congregation is working directly with the Millennium Villages Project in Rwanda (directed by Dr. Josh Ruxin, a regular contributor to the EGR blog) and in a formal partnership with Jeffrey Sachs’ Millennium Promise and the Earth Institute at Columbia University. Millennium Congregation is the first-of-its-kind faith organization to launch such an initiative with Millennium Villages. We hope that our efforts will draw all faiths together in partnership with one another and the extreme poor in growing the number of Millennium Congregation-supported Millennium Villages throughout Rwanda.

I invite you to read this Associated Press article, “Rwanda Genocide Victims, Killers Meet,” on the amazing work of reconciliation and transformation that Millennium Villages are doing in Mayange, Rwanda. After reading the article, I hope that you will pray about how your congregation gives to the work of advancing the MDGs and ending extreme poverty and if joining Millennium Congregation to help support the next Millennium Villages in Rwanda is one concrete way that you – and your congregation – can respond through faith to end extreme poverty.

If you would like to learn more about Millennium Congregation and our work with Millennium Villages in Rwanda, please contact me anytime at: JayRLawlor@yahoo.com and/or visit our website: www.millenniumcongregation.org beginning Monday, April 7th.

The Rev. Jay Lawlor is a priest and economist and currently serves as Associate Rector at Church of the Nativity in Raleigh, North Carolina and as Director of Millennium Congregation. He is the author of Faithful Action: How Each Christian Can End Poverty.

"Rwanda out front against HIV/AIDS" -- Dr. Josh Ruxin on CNN's Inside Africa

In this clip from CNN's Inside Africa, EGR friend Josh Ruxin explains why Rwanda has such an impressive record in the fight against HIV/AIDS.

"One of the health centers that the Millennium Villages Project is involved in, in Mayange, has done such a great job of improving the quality of health that a woman in the community approached me just last month and said, 'You know, I'm a little bit angry with you. I used to have a job in this community that I don't have anymore.' And I said, 'What exactly is that job?" and she said, "Well I used to coordinate the funerals here, and for the last eight months there hasn't been a single funeral, but just last year I was coordinating three or four funerals every single week."

Josh Ruxin is a Columbia University expert on public health who has spent the last couple of years living in Rwanda, where he administers the Millennium Villages Project in Mayange. He’s an unusual mix of academic expert and mud-between-the-toes aid worker. His regular posts can be found on the blogroll of Nick Kristof of the New York Times, and he has given his permission to be cross-posted here. Josh and EGR executive director Mike Kinman team-teach a global poverty module for Trinity, Wall Street's Clergy Leadership Project.

Hope in Rwanda

by Sarah Bush

I just got back from a trip to Rwanda. In fact, I’m writing this blog post in the middle of the night because I’m still really jet lagged. I went there for eight days with two fellow graduate students from Princeton University in order to conduct field research about the country’s 2008 legislative elections. We’re part of a broader class on the topic of “managing elections in fragile states.” I’m still processing what I saw, but let me share some reflections with you.

Anything that you might say about Rwanda today invariably must start back with the 1994 genocide. The memory of that tragedy, and the years of violence that led up to it, is still fresh. The fear of a return to conflict is real. Here is a view looking out over Kigali, the capital city of the land of “a thousand hills,” from the Kigali Genocide Memorial’s garden.

However when you are walking around along the streets of Kigali, the perspective that you get is a very different one. It is a bustling city with smooth roads and many cranes helping to construct shiny new buildings. As one young Rwandan woman observed, “When there is peace, you can build.” Indeed, Rwanda is making impressive progress on several MDGs; for example, the enrollment rate for primary school is 95% and there is no gender gap in primary education.

Meanwhile, the government is working hard to promote reconciliation and Rwandan national identity rather than ethnic identities. It’s taboo to ask if someone is a Hutu or Tutsi (and it’s impossible to tell by looking). If you did ask, the person would probably tell you that he or she is Rwandan, since everyone we spoke to recognizes the terrible consequences of ethnic divisions and does not want to go back to them. One genocide survivor, who still had palpable anger about the genocide, told us how his Christian faith was helping him try to forgive and raise his children to respect all ethnicities.

Despite all of the positive developments, Rwanda is still a fragile state, and a fragile democracy. Although everyone agrees that the country is headed in the right direction in terms democratizing, many disagree as to whether it is going fast enough. The media, civil society and political parties are particular areas of concern. We’re writing a report right now to describe ways in which international donors can and should address them. Building a democratic culture of peaceful political competition is not easy in a country with Rwanda’s history. Only time will tell, but we are hopeful.

Sarah Bush is a PhD candidate in International Relations in the Department of Politics at Princeton University. She has worked in the past with Americans for Informed Democracy, an organization on 1,000 colleges that works to raise global awareness among students, as its Co-Executive Director during the 2005-2006 academic year. Her previous experience also includes work for the U.S. State Department, the St. Louis City Mayor's Office and Teach for America.

Editor's note: We've taken the opportunity of Sarah reporting from Rwanda to give you some other views of this amazing place. Josh Ruxin, friend of EGR and administer of the Millennium Villages Project in Mayange, Rwanda, blogs regularly for Nick Kristof of the New York Times and has given us permission to repost ... which we have done below and will continue to do regularly.

Also, click here to download "The Rwanda Cure" from last month's Forbes magazine, that tells more of Josh's work (with great pictures!)

Tomorrow: John Hammock

The Word is Getting Out

Josh Ruxin is a Columbia University expert on public health who has spent the last couple of years living in Rwanda. He’s an unusual mix of academic expert and mud-between-the-toes aid worker. His regular posts can be found on the blogroll of Nick Kristof of the New York Times. This is his post from Sept. 28.

It was much to the dismay of family and friends that my wife and I moved to Rwanda. Having seen little more than “Hotel Rwanda” to educate them about the country, they believed it to be a hostile and unstable place. We had a different take: it’s safe, clean, friendly and relatively uncorrupted. Our perception is clearly shared by others and, now, the country’s resurgence is being recognized.

Tuesday, the Mo Ibrahim Foundation released the results of its “Ibrahim Index” — a holistic ranking of how African countries are doing across the dimension of governance. Ibrahim, one of Africa’s most successful and philanthropic entrepreneurs, set up the index to inform the Mo Ibrahim Prize — an annual award of $5 million for a former head of state who has demonstrated excellence in leadership. The surprise to all but Rwandan insiders was that Rwanda made the greatest progress of any country during the course of the last five years.

As the always insightful Steve Radelet pointed out in an earlier post, governance and democracy in Africa mean everything. Having worked in nearly a dozen countries in Africa, I decided to place my bets on Rwanda because it was the first place I’d never been asked to pay a bribe. I’m not alone: donors are lining up to invest in Rwanda, reassured that the money will reach the people who need it most.

None of this is to say that Rwanda is utopia: major challenges remain for improvements in the press and in democracy. Nevertheless, at a time when many nations are spiraling downward, it’s heartening to see little Rwanda making progress against all odds.

Click here to download "The Rwanda Cure" from last month's Forbes magazine, that tells more of Josh's work (with great pictures!)

Also, click here to download "Seeds of Change" from September's Time Magazine, which talks about progress in Rwanda and highlights how coffee is actually making this country richer rather than poorer.