Ramblings from Rwanda

Last week, to follow up our audit visits, we ran 3 training days (one in each district) on financial management for the Health Centre Accountants.  In preparation, I have spent the last few weeks writing up a summary of our observations and recommendations, finishing off the new financial monitoring and reporting templates for Health Centres to use, helping the finance team put together a finance manual for Health Centres, and preparing the training course.

For the first time since getting here, I felt properly stressed last Sunday night.  We hit printing issues - a small malfunctioning printer, no paper, and unsurprisingly, no one to help at 10pm on a Sunday evening.  And then there was the fact that I felt nervous about sitting through training courses that I have been so heavily involved in preparing and having absolutely no idea what’s being said.  But I need not have worried; we solved the printing problems early on Monday morning, and then the team did a wonderful job in presenting the course, a fact that was highlighted by the good understanding the Health Centre Accountants showed when they completed the training exercises, rather than a miraculous understanding of Kinyarwanda by me.

Stock takes, finance templates and lessons in debits and credits

At the weekends, I have been exploring the country as much as possible.  A few weeks back, we arrange a trip to Lake Kivu, and over 20 people ended up coming along.  Last weekend, fancying a quieter weekend and long hike, we set off in the general direction of some coffee plantations.  Along the way, we came across a dozen or so prisoners sitting on the side of the road, wearing brightly coloured-coded jump suits depending on the offence they had committed, and seemingly unattended.  Hundreds of their fellow inmates were working in the paddy fields in the valley below.  It really intrigues me that none of them seem to run off.  After a hilly 15 km, we felt almost triumphant to come across a coffee washing station, run by a women’s co-operative.  One of the women kindly showed us around, acting out the process as we knew only a few shared words.  And then we set off to walk home. 

The main project I am working on is the implementation of a reporting and monitoring process, which will support the recent expansion of PIH's activities to fund around 40 health centres.  The aim is for each health centre to submit a monthly financial return, with a budget summary, detailed breakdown of expenditure; petty cash count results and a bank reconciliation. The PIH district accountants will then visit each health centre on a regular basis to verify the reported expenditure, and monitor controls over general expenditure, payroll and cash.

Having developed a proforma for the health centre monthly returns, and an audit template for the PIH teams to use, I spent last week out and about with the Burera district team performing our first audits, and teaching the health centre accountants how to complete their monthly returns, how to perform bank reconciliations, and so forth.  Initially, it was planned that I would do a couple of visits with each accountant until they are confident with the process, but they have decided they want me to attend as many of the first audits as possible, so I should be kept out of mischief for at least the next month!  This week I am working with the Kirehe district team. 

A doctor who is working on a new sister project in Mali has been visiting for the past few weeks to try and learn lessons from the project here. He even seems interested in accounting and audit, so I’ve also been spending some time with him, teaching him debits and credits, discussing internal controls and explaining how to account for restricted funds.

A hospital fit for a President

PIH has been working in partnership with the Ministry of Health and the local community to build the hospital for the past two years, following a request by the Rwandan Government for help to bring health care facilities to Burera, the last district in Rwanda which did not have access to a hospital.

Since PIH started working in the district in 2008, in a temporary make-shift hospital, the rate of infant mortality in under 5s has more than halved and malnutrition has been cut by over 60%.  The project has also created over 3000 jobs for the population of Burera.  So there was such a buzz of excitement at what can be achieved now the new facilities have opened.  The hospital really is impressive.  It is situated on top of a mountain, close to Lake Burera.

In terms of facilities, the hospital hopes to become a model of how to deliver health care in rural Africa.  It features an innovative design intended to harmonise with the local environment and reduce the risk of hospital-acquired infections.  It has an emergency department; a full surgery ward with two operating rooms, a neonatal intensive care unit, the list goes on...  It will even be making use of the impressive hills to supply hydro-electricity.

Welcome to Rwanda

The country is absolutely stunning.  There is a perpetual backdrop of (often mist covered) hills and mountains, and the red African soil contrasts beautifully with the lush green vegetation.  The rain storms that sustain such plant life are pretty intense.  When it rains, it POURS, the tin roofs pound, the thunder and lightning sound worryingly close to said metal right above your head, and every pathway turns to a muddy water flow.  It is quite exciting!

I am now at my main base for the next 4 months, Rwinkwavu, in rural Rwanda (about 3 hours from Kigali, including a bumpy 45 minutes drive down a dirt track).  Having only been here for a couple of days, I have already become:

-          Fish-eating – I hate fish so when a plate was put in front of me with 2 barbecued fish smiling up at me and I was told “we eat it with our hands” I was a little worried, but it was actually yummy and eating it with your fingers takes away any fish bone worries;

-          Football watching - the first few days were a little lonely, so when I was invited to the local bar for the Man U/Liverpool game (and a beer), I jumped at the chance;

My name is Emma (or Robbo), I’m 26 years old, and am just starting a 12 month career break from my job as a Chartered Accountant in London. I am off to Africa on Thursday to work with Partners in Health (PIH), a charity based in Rwinkwavu, Rwanda. PIH provides primary health care services to rural Rwandans, as well as works to alleviate the root causes of disease in local communities.

Having spent 4 and a half years as an auditor, reviewing financial systems and controls developed by others, I am eager to experience the other side, and to take on the challenge of actually implementing some practical processes that will help to support PIH’s operations.

I am really excited at the prospect of all the people I will encounter over the next year, and what I can learn from them (I hope this includes at least a little Kinyarwanda).