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Doctor with ‘Sassitude’

Binagwaho’s work helped turn the war-torn country around, says Farmer. She insisted that health — physical, mental and social — was a human right for all. That meant reaching people everywhere, regardless of their ethnic group, location or income.

As a pediatrician, she saw children who were orphaned when their parents died of HIV. At the same time, some of her young patients were HIV positive. Rape was widespread during the war, and witnesses later reported that assailants announced their intention to infect women and girls with the virus. She believed in the importance of HIV treatment and prevention.

Binagwaho went on to lead Rwanda’s National AIDS Control Commission from 2002 to 2008. During her tenure, she and her team aimed to connect public, private and community sectors to provide better HIV care.

During those years, HIV care improved. According to the U.N., the number of people dying from HIV each year fell from 15,000 to 7,700 — 44 percent in six years. New infections were cut in half.

In 2008, Binagwaho began serving as permanent secretary in the Ministry of Health and was appointed its minister in 2011. To reach the country’s poorest, the ministry trained 45,000 people as community health workers, sending them into the homes of people who often don’t receive care. It also gave community workers cell phones that allowed patients to contact doctors through Twitter.

By 2010, maternal mortality dropped more than 60 percent from the 1990 figure. Life expectancy rose from 28 years in 1994 to 56 years in 2012. Health insurance coverage is practically universal at more than 90 percent, and the poorest receive free care. Despite being one of the poorest countries in the world, Rwanda has one of the fastest growing economies in central Africa.

Binagwaho utters a line that feels worn down with use, directed at skeptics who question the validity of spending money on health care in developing countries: “Health is key in development. It increases the GDP of the country. We seem just to spend money, but it’s not true. Health equity is a business plan.”

Despite her track record, she has faced controversy. In 2015, President Paul Kagame — who is both admired and accused of running a government that silences opposition — relieved her of her duties amid allegations of mismanagement of health resources. She defends her tenure by saying, “I served from 2011 to 2016, longer than any other minister of health in Rwanda and the President decided it was time for a change. I’m proud of what the team I was leading has accomplished.”

Binagwaho still lives in Kigali, Rwanda’s capital. She’s had more than 100 peer-reviewed articles published, including one in BMC Pediatrics on how Rwandan children with HIV often have depression and require better mental health care. She is a senior lecturer at Harvard and an adjunct professor at Dartmouth. And she’s counting down the days until she moves north to rural Butaro, where she is buying a plot of land to live near her latest project.

The University of Global Equity was dreamed up by Binagwaho, who serves as the university’s vice chancellor, and two other humanitarian-physicians, including Paul Farmer and Dr. Peter Drobac. They want to train new generations of health-care workers to provide services in the poorest of communities.

The initial $30 million funding came from the Cummings Foundation and the Bill & Melinda Gates Foundation (which is a funder of NPR). Though the construction of the campus is not yet complete, the university has 46 students. The first 17 graduated with a masters in global health delivery. Each two-year student receives partial financial aid for the $8,250 annual tuition.

 The latest batch of applicants come from 29 countries on four continents, according to John Urschel, director of the University’s partnership development. Urschel describes them as people “who are desperately looking for an alternative to the traditional idea of global health. These are activists who want to learn how to improve their communities, they want to learn how to marshal political will. They’re in the field and they’re frustrated with what they see.”

Nothing makes Binagwaho angrier than “unnecessary death.” She says she has watched too many people in the developing world die of treatable conditions just because they lack access to good health care. “Equity is in the heart,” she says. “Meaning you always make sure to include everybody, leave nobody out.”

The United States, says Binagwaho, has yet to learn that lesson.

Her fervent desire to help everyone and to prioritise the most vulnerable echoes back to her earlier days as a pediatrician in neonatal care.

“All life is very precious, but the beginning is magic,” says the mother of two daughters. “You are a human being and you just come out of water, discover the world and you scream. For the majority of births on Earth, I think, it’s a joy, this new life. It’s a mission that each human has — protecting life, giving life, continuing life.”

Source: npr.org

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