Agnes Mukarwema gently covers the head of her five year old son, Albert Butera, to shield him from the sunrays protruding through the hospital window. Albert has been in the children’s wing of Kabutare hospital for two weeks.

Mukarwema and her son traveled 47 kiliometres from her village of Cyinya in Nyamagabe district before reaching the premises of Kabutare, the biggest hospital in the Southern Province.

One Saturday night Butera’s persistent fever became worse. He was taken 11 kilometres to Nyamagabe health centre almost in a coma. The miraculous journey from the centre to the hospital that followed saved Butera’s life.

"My son was going to die if the authorities at the health centre had not called the ambulance from Butare,” she says.

Mukarwema attributes her son’s salvation to the improved performance of workers at her health centre. Her child now looks healthy; he can smile and hold a conversation.

"We shall be out of here soon,” says Albert.

"Had it not been for that ambulance, my child would be dead now,” says his mother.

Dr. Jean Claude Ntagarukanwa, the Director of Kabutare Hospital, explains that the hospital keeps three medical ambulances on standby.

"We have two that work during the day and one at night, the night ambulance is the one which collected Albert and his mother.”

He adds that the vehicles are part of many measures that the hospital has undertaken to improve health services to the more than 272,000 population it covers.

"We have sensitisation campaigns, distribution of mosquito nets, officially sanctioned malaria drugs, and are encouraging all people in the area through local government authorities to enroll for Mutuelle De Sante health insurance scheme.”

Such schemes are what have made Rwanda an African success story in the fight against malaria, says Dr. Corine Karema, the director general of the National Malaria Control Programme, PNLIP.

"We have adopted several mechanisms and we are hopeful that the disease will cease being a burden to the development of the country.”

Fighting the disease

According to the recent National Health Management Information Survey, the use of health centres in the country was at 75 per cent in 2007 while 73 per cent of the population use the Mutuelle de Sante schemes.

Through this scheme, Rwandans pay local government authorities a small fee after which they are given cards, upon presenting these cards at public health centres, patients are required to pay only 15 per cent of the total cost of treatment. This scheme has been particularly helpful among the rural communities where the levels of poverty are high.

Mukarwema is able to pay the bill for her two weeks stay in the hospital thanks to the Mutuelle system. However, Ntagarukanwa adds that these insurance cards are not being fully utilised by Rwandans.

"Many times we get young people admitted here after an accident or something, they don’t normally acquire these cards. The younger generation assumes that because they have no one to take care of, they have no need for Mutuelle de Sante cards.”

"Many times they have discovered the importance Mutuelle cards too late.”

In May 2008, Novartis, the manufacturers of Coartem, reduced the cost of the drug by 20 per cent, making it much more affordable. According to the World Health Organisation, Coartem, is the most effective drug in the fight against malaria.

Karema explains that now Coartem being subsidised, "with Frw300 as many Rwandans as possible can assess the treatment.”

Time are changing

For long malaria and its related infections have been responsible for 60 per cent of deaths in the country. Development experts have stated that it is a serious bottleneck to efforts in reducing poverty in the Sub Saharan Africa.

However currently, Rwanda is the model country among developing nations in combating the most serious health threat in the country.

The government in August 2007 adopted the Indoor Residual Spray (which has controversially been stopped since February 2008 by the national malaria control programme due to safety concerns) on top of massive distribution of mosquito nets distribution, cheap malaria drugs and the provision of safe and clean drinking water through supplying at cheaper rates water purifying substances.

Professor Michael Kramer, the director general of the Infectious Diseases Centre, said Rwanda is performing very well in fighting malaria, "we are on top of Africa in controlling malaria, we also named a model country by WHO in fighting the disease.”

In Huye District alone, malaria prevalence has reduced greatly says Ntagarukanwa. The prevalence of malaria among the total number of patients admitted in the hospital was 5.2 per cent and in May 2008, but this figure had reduced to 4 per cent of the total number of patients admitted in the hospital, explains the hospital director.

Karema says, "Under-5 child mortality rate through out the country has greatly reduced and the proportion of child deaths attributable to malaria is currently below 5 per cent.”

Ntagarukanwa says malaria is a big problem in the district but is no longer so alarming, "the Ministry of Health has set for us several measures to control the disease.”

He adds that the supply of insecticide treated mosquitoes as being particularly important in reducing the prevalence rate of malaria in Huye District.

According to Kabutare hospital records, there was only one malaria related death among the total number of patients admitted in the month of June.

Ntagarukanwa explains that a new plan, known as Home Based Treated of Malaria, trains health workers to regularly check on children with malaria complications in their families. The scheme targets children below the age of five.

"Here we have more cases of adults suffering from malaria than children because we have been able to monitor the health of every born child in the hospital. We do this through a broad network of community health workers, grassroots local government officials, public and private health centres through out the area which our hospital serves.”

After two weeks at Kabutare, Mukarwema is optimistic. She says her family faces the normal problems that poverty "carries with itself,” but health care issues are no longer a permanent worry.

"From the recovery of my son, I know health issues now have greatly improved.”

Ends