POST BY DANIELLE ALLYN // ORIGINALLY PUBLISHED MARCH 2016

Turikumwe means “we are together” in Kinyarwanda. This phrase embodies another fundamental Rwandan value of Ubupfura, which represents the act of having integrity and remaining a faithful friend in the good and bad times. At Gardens for Health, the value of Turikumwe manifests itself in the form of the Turi Kumwe Fund. The Turi Kumwe fund was initiated in 2011 by GHI employees who recognized that, while our intervention is designed to provide comprehensive and holistic solutions to malnutrition, vulnerable families will often struggle with challenges beyond what GHI’s core program is able to mitigate. In order to provide support beyond what seeds an education can bring, field staff instituted the Turi Kumwe fund, an entirely staff-funded, managed, and implemented endeavor. The fund would identify families struggling with severe and urgent threats to their health and wellbeing, and leverage the staff’s own resources to provide temporary, emergency support.

Across GHI’s 18 partner communities, many families face challenges when it comes to exercising their right to health, which is defined by the World Health Organization as follows.

“The right to health means that governments must generate conditions in which everyone can be as healthy as possible. Such conditions range from ensuring availability of health services, healthy and safe working conditions, adequate housing and nutritious food. The right to health extends not only to timely and appropriate health care but also to the underlying determinants of health, such as access to safe and potable water and adequate sanitation, an adequate supply of safe food, nutrition and housing, healthy occupational and environmental conditions, and access to health-related education and information.”*

GHI’s program model recognizes the multidimensional nature of health and malnutrition and focuses on lasting, sustainable behavior change and corresponding health outcomes for families.

In severe cases, however, the socioeconomic vulnerability of families often requires immediate intervention in order to prevent or mitigate health crises. GHI’s Turi Kumwe fund exists as an internal solution to this problem, repurposing staff contributions of time, expertise, and finances in an effort to enable all families to exercise their right to health.

In the GHI context, Turi Kumwe committee members navigate difficult decisions in allocating funds to respond to the exigent needs of partner families. The committee must identify cases of families who are in need of Turi Kumwe’s urgent support and vote on which cases to take on. Under the direction of four guiding principles: family best interest, impartiality, economic efficiency, and confidentiality, Turi Kumwe members complement the work of GHI in helping vulnerable families translate seeds into health.

Festus Bukangano, Turi Kumwe committee member and GHI Monitoring and Evaluations Agent in Nyakinama, Musanze, describes the staff-supported contingency fund as such:

“GHI focuses on destitute families, but one of the leading causes of malnutrition is poverty. TK supports individual cases, depending on their severity. This is a way of going beyond [the scope] that GHI reaches, beyond the limits of GHI’s intervention, because it deals with very serious cases at the individual or family level. Turi Kumwe is a reinforcement of GHI’s work in the community, so the stronger Turi Kumwe is, the stronger GHI as a whole is.”

Festus serves as a Turi Kumwe ambassador to GHI’s local partners, informing District and health center authorities of the fund’s impact. Furaha Uwimbibaza, GHI Field Educator in Muhoza, Musanze and likewise a member of the Turi Kumwe Committee, elaborates Festus’ definition:

“It is a support fund from GHI staff who want to support their local communities without always relying on external resources. We have taken what we have, and guided by a spirit of empathy, we have chosen to support families. It is a sacrifice that we make. It is not because we have a lot, but it is because of a caring spirit we have [that motivates us ] to support families facing vulnerable situations that GHI cannot support alone. We do not limit ourselves to providing that small portion of our salaries. We also advocate and work hand-in-hand with mothers.”

GHI’s Turi Kumwe Committee liaises internally among staff members to raise funds and externally with local authorities to explain the fund’s activities. Members advocate on behalf of vulnerable families, using advocacy as a tool to obtain support from the healthcare system, government authorities, relatives and neighbors, and local community organizations. The advocacy arm of GHI’s Turi Kumwe Fund stretches the Fund’s impact, filling in gaps left by limited financial resources. In the following excerpts, we introduce you to three GHI partner families, cases that, while each unique, represent the severity of situations that the Turi Kumwe Committee processes and the capacity of the fund to enact tangible change.

Ngiryi, Gasabo, Rwanda

Two generations removed from the two-year-old currently in her care, Immaculate smiles as Kevin hides among verdant banana leaves. Her even-tempered approach to caregiving conceals the vulnerability of Kevin’s situation. Immaculate and Kevin bear no blood ties.

“My children are grown so I needed a young one. I could not bear to see a child suffering with malnutrition when I know how I can help- so I took him as my own. I am like his grandmother.”

Immaculate graduated from the GHI program in 2012, one year after the inauguration of the Turi Kumwe fund. Empowered by her new skills, Immaculate found Kevin in need of help that she knew she could provide. Kevin’s mother relocated from rural Ngiryi to nearby Kigali city, leaving her son behind. While Kevin’s father remained in Ngiryi, paternal proximity did not inspire paternal support. Immaculate encountered Kevin temporarily bereft of a primary caregiver and malnourished. She resolved to intervene. Immaculate invited the boy into her home and provided nourishment from her own garden. Legally neighbors but informally family, Immaculate cares for Kevin by sharing her limited resources, and just as importantly by extending her love as a parent would.

Epilogue: The Turi Kumwe Fund worked alongside Immaculate to facilitate the purchase of milk-based nutritional supplements from Ngiryi Health Outpost. Today, Kevin’s physical health indicators show signs of improvement as a result of this intervention.

Gataraga, Musanze, Rwanda

Community Health Worker Edith traverses muddy ridgelines through thunderstorms to visit the home of Judith, a mother of two in Gataraga, Musanze. Judith has built a robust social network to help her through difficult times, but Judith’s neighbors affirm a decline in her social aptitude. She refuses to acknowledge greetings from friends and family and periodically neglects caregiving responsibilities, abandoning her two sons during episodes of mental and emotional crisis. Community Health Worker Edith recounts a recent family trip to Gataraga Health Center. Wounds-seemingly without origin-marked Judith’s body.

Judith’s testimony suggests domestic conflict, but her suspected condition casts doubt on the validity of recollection. To find certainty, Judith would need a psychiatric consultation. Though Edith and many in the Gataraga community suspect mental illness, Judith’s inability to visit the hospital regularly have made it impossible to obtain a diagnosis. Judith’s husband seeks permanent employment every day, motivated by the desire to provide a better future for his sons. The family often confronts an involuntary choice between paying treatment-related transit fees and other necessities. Judith’s husband remains steadfast in the face of his partner’s disconcerting and at times erratic behavior.

“When the mother [Judith] got that problem, it affected the whole family.”

Annonciathe Niyibizi manages GHI’s Turi Kumwe cases, acting as an ambassador for the Turi Kumwe Committee. She listens as Edith, Judith, and her husband discuss the family’s current situation, interjecting intermittently to ask questions about Mutuelle coverage and provide guidance on family planning strategy.

Epilogue: The Turi Kumwe fund offset transit fees for Judith to visit Gataraga Health Center for examination. The Fund also offered in-kind support in the form of SOSOMA porridge and soap for Judith’s sons. Currently, Committee members remain engaged in advocacy at the health center and village level, attempting to connect Judith with mental health consultation and care.

Bumbogo, Gasabo, Rwanda

At 20, Devine is not alone. Friends and well-wishers so effectively fill the youth’s home that Annonciathe must politely request the exodus of non-relatives, securing privacy for Devine and her son Brino. Brino has not recently received pediatric milk-based supplements, despite a diagnosis-malnutrition-that requires this treatment. Devine has not recently attended GHI health trainings, arousing the concern of GHI Field Staff. In response to Devine’s inconsistent program attendance, Annonciathe elected to visit the family on behalf of the Turi Kumwe Committee. Devine and her 21-year-old brother, Jean deDieu, reside an hour’s walk from Bumbogo Health Center, on paths conquerable only on foot. Jean deDieu peddles experience in agricultural labor to nearby employers, while Devine cares for Brino and their four-year-old sister, Kevine. Jean’s inconvenient but necessary absence situates the childcare burden firmly on Devine’s shoulders. The two share a roof and an intimacy with tragedy, maternally orphaned and paternally bereft. Devine is not alone. She can envision a future for herself and Jean deDieu. However, despite personal and communal resilience, Devine still daily weighs the burden of loss- loss accompanied by palpable economic consequences.

Epilogue: Following the composition of this story, Devine, Kevine, Brino, and Jean deDieu of Bumbogo, Gasabo received financial and logistical support from the Turi Kumwe Committee toward the purchase of Mutuelles de Sante (MUSA), Rwanda’s government-based health insurance program.**

In Ngiryi, Gataraga, and Bumbogo, Immaculate, Judith, and Devine struggle each day to access the right to health on behalf of themselves and their families. In Ngiryi, inequitable family dynamics consign Immaculate to informal adoption, thrusting her into the role of primary caregiver for young Kevin. In Gataraga, personal challenges in mental and emotional health complicate Judith’s ability to provide for her sons. In Devine, Jean deDieu, Kevine and Brino must endeavor to actualize their right to health amidst past family tragedy that continues to constrain available time and resources. GHI’s Turi Kumwe Committee has chosen to undertakes the emotionally exhausting and yet immensely rewarding labor of concrete action in cases like these in Ngiryi, Gataraga, and Bumbogo. In a typical Turi Kumwe meeting,

“We talk about the challenges we have encountered, successes and things that we are proud of, cases of families at different health centers, and what we are planning to do in the future. If we encounter a case that we cannot support, we try to analyze why, to problem-solve. In a notebook, we record every meeting. We have focal points at each health center, and we talk to these focal points to ensure that we are up-to-date on what is happening on the ground.” (Festus Bukangano, GHI Monitoring and Evaluations Agent, Nyakinama, Musanze)

“We have so many issues to deal with-sometimes we are overwhelmed by the number of cases- and we always look at the most severe cases. We wish to help the families that are suffering the most. Let us say we are looking at five families-we look to see which families face issues that are threatening lives. This doesn’t mean that we forget about other, serious cases- we put them on a waiting list, so that when we get more resources we can focus on the people on the waiting list.” (GHI Monitoring and Evaulations Agent Festus Bukangano, Nyakinama, Musanze, and Field Educator Shadrack Igiraneza, Busogo, Musanze)

Turi Kumwe advocates extend the reach of GHI’s standard program model, empowering staff to intervene in cases that require immediate attention. For some, Turi Kumwe support takes the form of financial assistance for medical transport fees or membership in MUSA. For others, support manifests at advocacy among local medical professionals or village, sector, or district-level authorities. For still others, the Fund offers in-kind donations in response to immediate nutritional, health, or hygiene concerns. While the locally-driven nature of the fund may at times impose financial constraints on its operation, its independent existence also enables Committee Members to accurately assess the severity of crises and respond with situationally appropriate solutions. Exemplifying the GHI ethos of going “beyond seeds” in the fight against childhood malnutrition, refusing to allow the urgency or severity of family need to preclude program success.

*The World Health Organization (WHO). (2015). Fact sheet: right to health. Retrieved from: http://www.who.int/mediacentre/factsheets/fs323/en/

**Government of Rwanda. (2015). Health system. Retrieved from: http://www.gov.rw/services/health_system/

Beyond the Seeds: The Turi Kumwe Fund