A shot of hope to take home

A Dundee scholarship scheme is helping one Rwandan woman polish her medical skills so she can apply them in the battle against HIV/Aids in Africa. Olga Wojtas reports.

"I thought Europe would be a sea of office blocks, but when we were travelling up to Dundee from Glasgow airport, I found that the landscape reminded me of home. Rwanda is called the land of 1,000 hills."

It may seem an improbable comparison, but these are Anita Asiimwe's first impressions of Scotland after she arrived in September as part of a new scholarship programme for Rwandan women.

Asiimwe, the coordinator of two anti-HIV programmes based in Kigali, Rwanda's capital, is one of seven postgraduate students on the one-year programme coordinated by Gerda Siann, emeritus professor of gender relations at Dundee University. Asiimwe is specialising in public-health strategies but her fellow postgraduates will study courses ranging from information technology to aquaculture.

She speaks with a calm tenacity about her studies. "What I pick up here, I will be able to use to help develop my country." Checking the spread of HIV is an urgent matter for Rwanda, where more than 10 per cent of the population has the virus.

Asiimwe was born and brought up in English-speaking Uganda, to which her parents had fled because of tensions in Rwanda long before the 1994 genocide. Asked if her parents are Hutu or Tutsi, she says: "If you would allow me, I won't answer that question. Because right now, what we are doing is to get together as Rwandan and develop our nation as Rwandan, be it Hutu, be it Tutsi, be it Twa (Rwanda's indigenous people). We want to work hand in hand."

She decided to go to Rwanda in 1995 when the new government urged those in exile to return. "It occurred to me that I should go and find out more about my home. There, I learnt that the university was restarting after the war. Before the war, it was mainly French-speaking. I went to find out if people who didn't know French could study, and I was told: 'Yes, why not?'"

In fact, the medical course she took is run in English and French to accommodate exiles.

Asiimwe consistently plays down any difficulties she has had in returning to Rwanda and studying. She concedes that her widowed mother must have feared for her safety, but her mother gave her blessing when she saw how determined her daughter was.

Educating females is a priority in the aftermath of the 1994 genocide that left some 800,000 people dead. They make up the majority of Rwanda's population. Asiimwe hopes that the government's recent decision to offer primary education free of charge will help combat the tendency of families to educate sons rather than daughters. She would also like to see more girls remain in school despite pregnancy, which causes many girls (most of them uninformed about contraception) to drop out. Girls are barred from school while pregnant because they are felt to be a bad example. Asiimwe wants to see this mindset change. "The parents feel let down and don't give this child a second chance, which I don't think is right. That shouldn't be the end of their study. We still have the spirit of the extended family (in Rwanda), and if the family has someone who could babysit, girls could carry on with their education."

Asiimwe herself would like to encourage girls in primary school to be as ambitious as boys. "I was thinking of targeting young girls, telling them while they're still young that being female doesn't make the brain in their head any different from that of the boy sitting next to them. Somehow males think we can't perform like they do. It hurts me."

At university, Asiimwe, who was sponsored by the government to study medicine, says she encountered no sex discrimination. But she adds that the women's academic performance was so good that it was impossible for them to be "overlooked". She was one of only four women among 31 students in the final-year English-speaking medical class; ten of the 35 students on the French-speaking course were women. Failure rates on the five-year degree were high - more than 180 students left for academic reasons.

Although Asiimwe's courses were taught by English-speaking lecturers brought in from abroad - mainly Uganda, Canada, Ethiopia and Cameroon - she had to learn French for work on the wards. "All of us were encouraged to learn the language we did not know. If I went to a ward and the professor was from a French background, it was me who had to adjust to be able to understand and communicate with him in French."

Medicine, Asiimwe says, was always going to be her calling - Jfrom childhood, she wanted to help those in pain. But in her fourth year of study, her experiences on a ward where most patients had Aids shook her resolve. Rwanda's government cannot afford the antiretroviral drugs that are used in developed countries to combat Aids-related illnesses, and Asiimwe saw patients treated and discharged only to return a few months later with another illness and, eventually, to die. "At that moment, I asked myself, 'Why did I go into medicine if I'm just going to look on while the patient slips out of my hands?' If one of your patients dies, you feel very bad about it. You forget all the patients who recovered and went home. But I think medicine is the right thing for me."

Asiimwe has found Scotland to be more welcoming than she had expected. "I had an idea that Europe would be so busy that no one would have time to stop and help you. But people are friendly, and the lecturers are very welcoming. I like the way people are." None of the Rwandan students has reported any difficulties with racism, she says, and she has not experienced any discrimination: "It hasn't occurred to me if it is there."

In Scotland, she has seen close up the differences between how HIV is treated in a developed country and in Rwanda. Does it upset her? "My classmates ask that question. I don't get angry at all," she says. "But one thing I would convey to the youth of Scotland is to try very hard never to get infected with HIV. They're informed about HIV/Aids, they are not illiterate, not ignorant like the people in Rwanda, (where some) don't even know it is a disease that is transmitted through sexual contact."

Back home, Asiimwe focuses on prevention through better public health information. Already, local political and religious leaders are helping health professionals spread the message, even using radio broadcasts. The World Health Organisation has reported that the incidence of HIV is falling in Kigali - Jthis encourages Asiimwe, but she says greater efforts are needed.

In Rwanda, HIV patients can find it impossible to follow even the most basic advice that the clinics offer. "One of the things you can do is have a healthy diet. But I was seeing mainly people who were poor and could not afford it. They look at you and it's like, 'Thank you for telling us, doctor, but where are we going to get it?' I wish I could afford the food for my patients. Oh, how I wish."

There is, nonetheless, some good news. Nevirapine, a drug donated to Rwanda by a German drugs company, has been helping to prevent the transmission of HIV from mother to baby. Mothers coming for antenatal care are encouraged to be tested for HIV/Aids. If the results are positive, the woman can be treated. "A single dose is given to a mother when she starts her labour.

After the birth, the child is also given some droplets. If the child is negative, you jump up into the air and then you go on teaching this mother, because one of the ways of getting HIV is through breast milk."

Exclusive breast-feeding is safe, Asiimwe says, but the virus can pass into the baby's circulation if it suffers any injury to the mouth. National guidelines have encouraged formula feeding to avoid the risk of HIV, but ignorance about hygiene means that bottle-fed babies risk dying from other diseases such as diarrhoea.

Doctors and nurses can assess what is best in individual cases, but this is possible in only a tiny minority of cases when there is just one doctor for every 41,000 people. Things are not always straightforward. A mother may appear unhygienic, but she may have walked for miles to the clinic, Asiimwe says. "Or the mother might say, 'I came here because I had a severe pain and couldn't pass by my house to get off the soil from the field'."

If the mother knows nothing about hygiene and has enough milk, Asiimwe would advise her to breast-feed. "If after one year, the baby is negative, thank God. There is something you have achieved," she says.

"At the end of the day, we have many people who are learning about Aids and then we have babies born and growing up without it. In my years of living, will I be able to see Rwandans view Aids as a disease and not a death sentence? That's what I want to get to."

Contributions can be made to the Scholarship Fund for Rwandan Women through the Royal Bank of Scotland; sort code: 83-50-00; account no: 00168795; Scottish Charity no: sc028299.