Tuesday, January 31, 2012

Taking Shape and Getting Started

So you have an idea of how WeAct was started and the mission of the organization, this last week has provided for additional assessing of needs and has provided a scope of work for me to begin. But first I will give you a little background info.....

WeAct's HIV+ youth population is struggling with adherence to their medication. For those of you unfamiliar with HIV treatment (which I am learning as I go). There are levels of medication (ART) 1-3. Level one is one pill daily and which most people are able to stay on for roughly four years before having to move to the second level, however if you do not take your medication on a daily basis than your body can not fight the virus and you are moved to the second line to get the virus under control. The second line is 9 pills daily ( 4 in the morning and 5 at night). For a large group of WeAct (a global problem not specific to WeAct youth) is having multiple barriers in taking this on a daily bases, thus many are putting themselves at risk of shortening their life span and risking death within the next few years if not adhering. In addition level 3 ART is not available in Rwanda. So if level 2 is not working for you any longer, you are essentially out of options.

Focus groups and psychosocial assessments have established that barriers to ART adherence are too many pills, pills are to big, and bitter tasting; depression, hopelessness, and self deprivation; gender based violence; and social stigma. For many youth they live in fear of disclosure of status, many have not told anyone, they fear someone seeing them take meeds, hearing the pill bottle rattle in their school bags. HIV is still shrouded in myths and misconceptions of transmission. Many live with caregivers (1 out 4 are orphans) that isolate them by making them have separate dish ware or treat them differently then non HIV youth in household by not sending them to school for example.

The US consultants (a medical physician and a psychologist) have been working on a substantial grant that would implement an intervention using Trauma- Informed Cognitive Behavioral Therapy to train Youth Leaders to run peer groups to work on changing the negative thinking surrounding HIV, social stigma, depression, and trauma. For resource limited communities this has been a way to intervene and provide psychosocial education and support.

So, essentially my role will be multifaceted. In part, (a) I will be working with the youth counselor to consult on using TI-CBT with the youth she sees in individual counseling. There are a few youth who speak English, so I will be sitting in on the sessions (I was able to sit in one a session yesterday to get a feel for the process and have to say I am very much looking forward to client contact). For other cases, we will be doing case consolations weekly. (b) I will be working with the child psychologist to develop a psychosocial assessment for children 6-11 to help build preventative care for younger children with depression or other mental health indicators. (c) I will be developing a curriculum for the TI-CBT intervention psycho educational section (cross your fingers that the grant is approved) for both the Youth Leaders and corresponding parent workshops. and (d) provide follow up CBT training for the WeAct psychosocial counselors. Did you get all that? cause I'm not sure I do!!!

In the meantime, I ventured out of the city about 5 hours southwest to Nyungwe Forest National Park this last weekend and hiked through the rainforest, no wildlife, but the foliage was incredible. Here are some pictures to share...so beautiful, refreshing to be in nature!









Saturday, January 21, 2012

Let me introduce you to WeAct

Although this week has been filled with the time consuming task of grant writing in an effort to be able to keep services up- and- running and to branch out... instead of going into details, I would rather tell you about the my placement organization.... in the mean time just keep your fingers crossed that the grants are approved!

The 1994 genocide perpetrators utilized rape as weapon to infect Tutsi women with HIV. The result  continues to effect the women and youth of Rwanda seventeen years later. Post genocide, an influx of ART (antiretroviral treatment) was given to the Rwandan government to address the HIV pandemic. However, the government decided to give the ART to male prisoner, genocide participants.

 Rwanda has a long  history of women collectively forming associations to address the betterment of their communities, so several associations made an effort to address this social injustice.  In response, The Women Equity for Access to Care and Treatment (WeAct) was established in 2004 with the mission to provide HIV medical care to all women and their children (mother to child transmission).

With U.S. AIDS research and medical physician collaboration with the women's associations,  began the journey to establish a clinic to serve the HIV infected victims of the genocide. Once the intake process began, the emotional trauma was an apparent need to be addressed, in addition to the medical care. Often in post conflict regions, lay counselors are trained in trauma counseling. So, partnering with Heartland Alliance (a Chicago based non profit) providers of trauma services both domestically with torture survivors and internationally with various post conflict regions, biannual training continues to take place with a staff of all Rwandan psychologist, psychiatric nurse, and three trauma counselors.

WeAct currently works with over 2,200 patients providing holistic medical and psychosocial care, income generating training, and legal advocacy.

My internship role is still in the works of being fleshed out, in the meantime, we have another grant for this week to write.

Saturday, January 14, 2012

Hills of Rwanda

Ahh..... So we begin the narrative of my experience interning in Rwanda. However, my internship starts next week and I have only had a brief visit to the organization to make acquaintances. Monday will begin my emersion and hopefully, after meeting with staff, a clear project plan will emerge for my time here.

In the meantime, the geographic beauty surpasses my expectations, I have yet to leave Kigali ( the capital) yet am surrounded by lush foliage, beautiful flowering bushes, and the birds here have a sound of their own (which I will try to video... you have to hear this). I am so anxious to explore the rural areas, but have to say that the city life ain't half bad :)

This week I attended a conference by World Learning on Conflict, Memory, and Reconciliation. I went with the expectation that they would be discussing applied case studies or interventions, however, the content was more theoretical and conflict analysis. Interesting, to be honest a bit over my head, but I came away with some insightful questions surrounding using testimonies, the manipulation of historical narratives as truths, and that memory has individually, collectively, and nationally variations that can create both silence and conflict. The critical analysis application to various global conflict should me my own limitations or lack of seeking to understand the side of all participants in a much broader realm ( which embodies social work principle but can often be negative without sufficient background analysis). However, the lack of application was a disappointment due to lack of tangible illustrations.

Today, I had the opportunity to present a research proposal on behalf of a clinical psychology graduate student ( and fellow Kovler intern) to the National Rwandan Ethics Committee. Although, the panel was gracious in their feedback and questions, it was a bit stressful in the hope that they would find the research significant. The proposal is to conduct a 6 week module on Compassion Fatigue for trauma counselors with WeAct ( the organization I will intern with). I have taken on the role of research assistant and am hoping that this comes to fruition.


Plan to takes some picks over the weekend to at least share me lodging (which is amazing) and share the scenery.

Best Regards