From Gary Strieker, Special to CNN
Burera, Rwanda (CNN) — Childbirth is the number-one killer of young to middle-aged women in developing countries, and one of the worst-affected countries is Rwanda, where maternal mortality rates have been dire.
But a new rural hospital is transforming the local health system and offering a model of how to turn around the situation in the country.
The Butaro Hospital has been built to provide quality healthcare in one of Rwanda’s most remote districts. Just a few years ago Burera district only had one doctor for its 350,000 population.
Dr. Agnes Binagwaho, the Rwandan Permanent Secretary of Health, welcomed the new facility. "There are too many deaths that we could prevent by increasing access to care in a geographic way and also increasing the expertise of health professionals that deliver services," she said.
The first baby to be born at Butaro Hospital had difficulty breathing, but he survived. Health professionals say this may not have been the case if the delivery had taken place at home or in a rural health center.
The hospital, built on top of a hill, is a beacon of hope in a country with many scars.
The mother and unborn baby were able to take advantage of the trained staff and quality equipment at the new facility. But Rwanda’s government could not have built Butaro hospital without the help of others.
The U.S.-based non-profit Partners in Health, which has built hospitals and clinics throughout the developing world, provided expertise and more than $4 million for the construction.
The Clinton Foundation also provided support, while the Rwandan government has covered the cost of the hospital equipment.
Dr. Peter Drobac is the country director for Partners in Health and believes the hospital represents the way public-private partnerships for development should work.
"We’re here to help support the government implement their roadmap and do it effectively, and they gave us the space to try new things and to innovate," he explained.
Drobac said that the innovation included effective but inexpensive design features that could be replicated across the developing world.
For example, to stop the spread of diseases like tuberculosis (TB), patients gather in the open air instead of confined corridors. In the wards, every detail has been carefully considered — from the smooth resin on the floor that can be easily sterilized, to ceilings that improve ventilation.
"Number one, the ceilings are high and vaulted and at the upper level there are these non-operable louvered windows, and that allows air to pass up and out. It’s something called stack-effect ventilation," Drobac explained.
Drobac said that there are also ultraviolet lights that kill TB bacteria and other microbes in the air.
"Those things collectively can actually achieve the same degree of ventilation and infection control as we do in United States hospitals at a fraction of the cost," he said.
Cost is key in a country like Rwanda, which is still recovering from the 1994 genocide that left an estimated 800,000 people dead.
In order to develop a better health system the government is implementing a pyramid-based structure with the district hospital at the top.
At the base level, every village has at least two community health workers. They are the first link in the chain that connects the villages with the health centers, and the centers with the hospital.
Among other tasks, community workers handle home visits with HIV-positive patients. They are trusted members of the village with rudimentary training to monitor those on medication and spot possible cases of common conditions like TB, malaria and malnutrition.
If there is a serious case that cannot be treated at the community level, the patient is referred to the hospital.
In particular, the strategy has drastically reduced maternal mortality in a country with one of the worst records in the world.
Until recently most women in Rwanda gave birth at home with no trained health providers on hand. In too many cases a complication resulted in the death of the baby and sometimes the mother as well.
Now, the community workers encourage women to give birth in the nearest health center, which has trained staff who can handle routine deliveries. If there’s a problem they send the patient to the hospital.
"A couple of years ago we had eight deaths a day in Rwanda, and now we are at less than one death a day," Binagwaho said.
"Even that is too much, but it does mean there’s progress. But we should reach the point where we have zero deaths that we can prevent."
Editor’s note: Gary Strieker works for Global Health Frontline News, a special reporting unit with funding from non-political foundations.