Agnes Binagwaho: fighting for the vulnerable in Rwanda
Dr Agnes Binagwaho was Minister of Health during the aftermath of the 1994 genocide in Rwanda. She is now the Vice Chancellor and Chief Executive of the University of Global Health Equity, where support for the vulnerable is at the top of the agenda. In the run-up to the WLGH conference, she spoke with Elmien Wolvaardt Ellison about the transformation of the Rwandan health service, her plans for the next Women Leaders in Global Health Conference and the childhood experience that set her on this path to excellence in global health.
You led the redevelopment of the Rwandan health service after the genocide in 1994, and Rwanda is now considered the best country in Africa for a girl to grow up in. What did it take to bring about this change?
The story of Rwanda is the story of a change of mindset. It started with the worst genocide ever: killing 1 million people in 100 days without bullets; just with machetes. Convincing people not to go for revenge, but to see how, together, we can build something totally different, how we can forgive people and also make them responsible for what they have done, even if they were misled by bad leadership; this was the first change in mindset that was the foundation upon which the new Rwanda was built. What was done in the health sector was totally embedded in all of this.
What did you decide to focus on, and why?
We reflected on the value of human life, education and what it means to segregate people and discriminate against others. The remedy to this is inclusiveness and protecting life.
Most important is the development of a country based on human development. Not development based just on economic growth, but based on how we can bring with us those who cannot cope with the speed of modernity because of lack of education, because of trauma they have faced in their life, or because of illness. That is what has changed the trajectory of Rwanda: equity, taking decisions based on evidence, sustainability (based on human needs and human possibilities) and developing the capacity to think out of the box.
What made it possible?
We did a lot of advocacy, because what we were proposing always seemed too expensive, or unrealistic, or unsustainable. But we believed in what we were doing and did not compromise who we were.
At the University of Global Health Equity we teach people to look for the social causes of illness: most of the time it is society that creates the conditions that the poor and vulnerable find themselves in. We teach our students to think about how to treat the cause, not just the symptoms, and how to create an environment that welcomes proposals to improve wellness.
The University for Global Health Equity will be hosting the Women Leaders in Global Health conference next year. What are your plans?
We will focus on Africa, but the problems are universal. I used to say that global health starts where I have my two feet, and that each and every individual is the centre of global health. In low- and middle-income countries, women have to care at home, they are health workers in their community, and they are nurses and midwives. They are the majority of health providers, but they are the majority of those who are not recognised. Even women doctors are exercising their power over women nurses who, in turn, exercise their power over community health workers – not always in a good manner.
This is the discussion that we are going to put on the table at the conference next year; not necessarily as privileged women – as I am – who have the chance to sit and write, and do research, but as these other women leaders in global health; our sisters who are the major providers of care.
Someone like you, with your approach to life, doesn’t come out of nowhere. Who influenced and inspired you to be a fighter for justice, equity and inclusion?
Many people have influenced me, but the person who influenced me the most is a nun. I was seven, and it was my first day at primary school – a Catholic boarding school in Belgium. We had just received a book (I was go proud to have my first book!) and I quickly looked through it. There were beautiful pictures, but none of the people were black. It was about religion, with pictures of paradise with a white God, white angels, and white people. The first black person I saw was in hell – it was an ugly devil! I I asked my teacher, why is the only black person in the book an ugly devil?
She punished me, but I didn’t know why; because I hadn’t figured out what racism was yet. Although I’m not sure that she was racist; perhaps she was afraid of racism and not ready to talk about it. So she put me in the corner and humiliated me in front of the whole class. But I was not humiliated. I was proud that I had asked a question because that is why I had come to school – to learn.
And I did learn three important lessons that day: First, I will never trust an adult just because he or she is an adult and has a position. Second, I will find the solution to my question. If I want a true answer, maybe I should search for it myself and not ask someone else. Third, this is in an injustice. I decided that I could be punished and be sent to all the corners in the world, but I will always ask my hard questions.
Have you ever mentored anyone?
Yes, I love it! I’ve learnt so much. You don’t mentor and believe that you give; you mentor and you receive so much.
If you had to give advice to women who know they have potential and what they can do, but are facing obstacles, what would you say to them?
Never give up. Follow your passion, with integrity. You will always make it. And if you don’t make it, you will make the way easier for others.
Dr Agnes Binagwaho spoke at the Women Leaders in Global Health Conference 2018 in London. You can watch recordings of the event here.
About Elmien Wolvaardt
Elmien Wolvaardt is the Editor-in-Chief of the Community Eye Health Journal, an international publication for health workers, clinicians and policy makers responsible for eye health and the prevention of blindness in low- and middle-income countries. The Journal is published by the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine and is distributed free of charge in print and electronic formats, in three languages, to over 23,000 readers in 134 countries, thanks to the generous support of charitable organisations and foundations.