FGHL Emily duBois RwandaWhat is a statistic? A number to identify a need. A number to justify the need for funding.  A number to create and implement programs, solve the problems that are determined by the statistics, the numbers. 

But who is a statistic?  A statistic is a person, a mother, daughter, sister, an aunty.  She is the nameless woman that gets added to the reports about the problems, the needs, and the gaps to be filled. 

So why do we care about statistics – well, because they give cause for funding.  They provide hope in sometimes seemingly hopeless situations.  The maternal health statistics in Rwanda are good in comparison to the region, but this brings up two issues for me. The first is that being okay for a region does not mean that it is good enough.  And although Rwanda has made incredible strides there is such a great gap to fill.  

Secondly, the progress has been made but how good is it? What does accessible, equitable care mean?  Does it mean that all women get to give birth in a hospital clinic or hospital?  But what if that means laying on the floor while laboring because there are no beds? How do we, as a community, connect the disconnect in what it means to have childbirth that is managed based on the most current clinical guidelines? 

Reading the state of the world Midwifery report, it is evident that Rwanda has made tremendous strides in healthcare, and particularly maternal and child health. Yet being on the ground, partaking in these women's experiences I cannot reconcile what I see on paper from the practices, beliefs and way people are treated during some of the most vulnerable times of their life. 

This isn’t a criticism of individuals, this is an assessment of the system that is in place and that can, with a bit of effort, be changed.  Making the shift from practitioner-centered care to patient centered care, more education on current, evidence-based practices, implementing hospital-wide guidelines, holding individuals accountable for their level of care, and instituting a more holistic approach to the healthcare system seem to be the missing pieces to the puzzle – or the puzzle itself.  And most importantly removing "but this is Africa" from the vernacular.

"Emily this is in Rwanda, we make due with what we have." And although I can appreciate this point, and understand it to its fullest, it doesn’t mean that it is acceptable.  Because we are in Rwanda, does that mean that hospitals shouldn’t have access to the best quality equipment, women shouldn’t have access to the best care possible?  I think not. 

A good friend of mine brought this up in a discussion we had once during a class in school. We were discussing inequity and someone mentioned “but that’s just the way it is” and she retorted – but is that okay?  And I think not. I don’t think it is okay to just say TIA (this is Africa), because that inhibits progress, it prevents us, as a global community, to demand more from ourselves.  Because each statistic, each woman, deserves the best and if we continue to perpetuate the "this is the best we can do" excuse then we will continue to fail.