Ministry Stories
Sister Mindy McDonald, CSJP
Sr. Mindy spent one year mentoring HIV/AIDS nurses in Rwanda with the Clinton Foundation.
Read her Journal:
Part One 
Part Two
Part Three
PDF documents require the free
Below are some excerpts from Sr. Mindy's journal.
Tuesday 30 October
We conducted the first of our site revisits today to confirm the follow-up on the children. The northeast is a big change in landscape. Broad, low hills, mostly used for cattle grazing, look very different from the tiny plots on steep hills so typical of the rest of the country. This area was once part of the Akagera forest, but has been cleared for pastureland. Acres of nibbled-low grassland are punctuated by hillocks, stands of cypress, shrubs and lines of a bush that is a favorite for property demarcation.
The staff at the first site had located many of the children lost to follow up, and had begun antiretrovirals on the children we'd identified. A phone call to Martin confirmed my concerns about some of the doses, so the nurse who is responsible for the HIV clinic will bring those kids in next week to adjust the doses.
At the second site, nurse Jacques (also Rwandan) has made a huge effort in home visits. With great persistence he has identified nearly all the children, as well as additional siblings. On his rounds in the villages, he saw a few kids he knew were positive, but hadn't seen in clinic for a long time. They were sick, and he persuaded their parents to bring them in for treatment. Home care works!
We know the statistics on children and HIV are nightmarish, but for me they are beginning to have names now, and nurses who tell me their stories. As we went through the list of identified children, Jacques told me about each child. One orphan, who lived with his grandmother, was taken to Uganda by an uncle, and grandma has not heard from them in over a year. Another was living with a family who mistreated him, so he ran away. One little toddler died a terrible AIDS death, and her big brother said to their grandmother, 'we can't stay in this house anymore; too many of us have died here.' This little boy is positive but healthy, and now comes in to the clinic for checkups and to see his new friend the nurse, who gives him support and encouragement.
After the site visit, Jacques brought me in to the hospital to see his wife who had just delivered their first baby. They were thrilled with this new life, and I was thrilled too, to be invited in to share their joy!
Later Eugene and I drove back to Kigali. As we passed through his neighborhood he pulled over and I met his 14 year old son, whose English is shy but he has the same chuckle in his eyes as his dad! So it has been a full day, of lives shortened and lives beginning, and hard lives, and good people who have the heart and skill to gentle some lives a little. It is a privilege to be here.
Much love to you all. You are in my heart.
Mindy
Sunday 28 Oct
The HIV mentoring plan has been a work in progress since my arrival. The project of identifying HIV+ children who are lost to follow up began as simple record keeping at a few mentoring sites, and is now a national project with the goal of visiting all of the rural hospitals and health centers that administer HIV meds (over 150) within the next month. The Rwandan Ministry of Health has five UNICEF-sponsored mentoring teams like ours (except they are Rwandans) working on this project. We identify children in four categories:
A. Children who are in need of treatment but who are not receiving it.
B. Children who have not had a CD4 count drawn in over six months.
C. Children who have not been “staged” by a doctor (using WHO's HIV staging.)
D. Perinatally exposed children older than 9 months who have not been tested (or, older than 18 months who have not been retested.)
Four to six weeks after our initial visit, we will return to the sites to confirm that the identified children have been seen and either treated, evaluated or tested. When we make visits, we do some staff in-services, answer questions and give support. We also bring clinic issues back to the team (for example, running out of medications or supplies, or inconsistent lab results.)
This work is to be completed by mid-December, and it will probably be mid-January before Martin and I go to one of the rural districts for six-week mentoring. So Kigali will be my home for a few more months.
Christmas
Emmanuel was thirteen during the genocide, and spent days hiding in the ceiling of his house, and nights foraging for food. During those weeks alone, he decided that if he survived he would devote his life to helping children, and he has since opened a center for children without parents. The young adult orphans bake bread to sell, and the proceeds help fund the center's programs.
About 70 school-age children who've lost parents to genocide, AIDS, prison or whatever are housed by families in Kigali, and Emmanuel's group pays their school fees, and runs an after school program for them. About half of the children were invited somewhere for Christmas, and the rest came to the center. Allison received a donation for the dinner (including meat, which they almost never have) and we all pitched in for gifts and decorations.
We all had such a great time! Candy is a rarity, and it didn't take much for a sugar high to kick in. The kids were wild with excitement about crayons and drawing tablets, and just loved being held and attended to. We didn't have a lot of language in common, so mainly we just played, drew, laughed, took pictures, etc. Kids older than you'd expect wanted to be picked up and held and kissed, and everyone wanted their photos taken! Jill took loads of photos and brought her laptop, so she could give a little slide show of the day before we went home. The kids were thrilled to see their pictures on the screen.
We sang Christmas carols to the children in English while they ate dinner, and they sang for us at the end of the day. I think everyone was a little giddy with the energy, including the eight umuzungu types, from Canada , England, US and Mexico. It's a Christmas we won't soon forget.
Wed 20 February
The HIV nurses and social worker at the hospital are doing well, and I like their interactions with the patients. They are very hospitable with us, and eager learners. Down the road from the hospital, some Sisters, who raise a few cows, sell milk and yogurt in their foyer. We usually go there at lunchtime with a few colleagues. The nuns know the hospital staff regulars, and often sit and chat with us for a few minutes. We have some laughs with our French and Kinyarwanda!
Sat. 5 April
This month is set aside to remember the genocide of 1994. It’s a somber time. Although it seems long ago, no one here is untouched by this tragic history. And the poverty is so great that the struggle to meet physical needs must take precedence over mental health and healing needs. The country continues to work towards reconciliation, though, and the effort is to move forward as one Rwandese people.
I continue to hold in prayer all those who have lost loved ones, all upon whom violence has been inflicted, and all who have committed acts of violence, for whatever complex mix of reasons. May our common humanity, and our common power and frailty, hold us close.
Wed. 4 June 2008
Oh, it’s been too long…sorry for not updating more regularly! We’re in our last week of Kibungo area health centers. I’ve also had the privilege of going to the national parks and seeing some incredible wildlife.
It’s true that the year has gone fast. Because of the project we worked on all fall, the actual clinical mentoring started for me in January of this year. It takes time to get the lay of the land, and now that I’m comfortable in the mentoring role, it’s time to come home! Recently it has become clear that coming back to Rwanda would be a good use of the experience I’ve gained so far. So after some key conversations with some of you, I’ve accepted the offer to return in September, to finish out the year. I’ll be home again for good by Christmas! At right, Mindy giving a presentation on HIV medication and one of the nurses using a graphic.
End of November, back in Kigali
Next week will be some short trips to some of the sites where we made earlier mentoring visits. We’re repeating last year’s study of looking at pediatric HIV charts, to find children lost to follow up or to treatment. This time though, we’ll compare our results with last year’s, to assess our mentoring impact. It’s not the whole country, like last year, with all the TRAC mentors; it’s only our two Clinton Foundation teams. We’re doing an internal, informal comparison of our sites, pre- and post- mentoring.
Then, the last week I’m here, we’ll be completing and presenting our report to TRAC. And closing up shop, since the Clinton Foundation’s whole HIV clinical mentoring operation is moving to Burundi in January. Rwanda is doing fairly well with HIV care, and now has plenty of international help, both financial and technical. Burundi is so much poorer, and less well-organized, that the health care situation is by now lagging behind, so that’s the next HIV mentoring focus. But the other parts of our office, the Rural Health Project and the Development Initiative, will stay here and continue work on agricultural, development and health scale-up projects.