Dalia Mukandalijimana, 40
Dalia Mukandalijimama, 40, is HIV positive and uses her bicycle to get to and from her doctor's appointments. She and her husband also use their bike to take other patients in their village to the hospital for treatment.

By Falguni Vyas, World Ark contributor
Photos by Olivier Asselin

For years, Dalia Mukandagijimama, like many others in Rwanda’s Eastern Province, lived life in recovery, bearing the scars of unthinkable hardship. A partnership between Heifer Rwanda and Partners in Health joins the forces of health care and nutrition to help Dalia and others like her build thriving and surviving families and communities.

ABEZA VILLAGE, Kayonza District, Rwanda — As a storm rolls in, Dalia Mukandagijimama, 40, sits in her quickly darkening living room with her husband, Claudien Mvuyekure, 47, at her side. Their girls, Siveta, 8, and Cynthia, age 3, idly play at their feet. There is strength in Dalia’s warm and smiling eyes. Her voice is weary with the grit of a person who has seen more than one lifetime should allow.

Dalia is the eldest daughter of a Tutsi mother and a Hutu father. Early in the spring of 1994, she was just 20 years old, engaged to Claudien and busy planning an April wedding. Her father, who had since passed away, left behind three Hutu wives, and her Tutsi mother. Dalia’s mother was her father’s first wife and the source of much jealousy among the other women. The women fought constantly, mostly because Dalia’s stepmothers did not approve of her mother’s standing in the family hierarchy. And it was Dalia who had to deal with the brunt of the resentment. Tensions came to a boil when the wedding planning was in full swing. Her stepmothers, along with her stepsiblings, decided to take revenge against Dalia and her mother by ruining her upcoming nuptials. Together, they plotted, and a horrific idea was born.

That March, they hired a group of men to rape her. Unbeknownst to Dalia, the men were HIV positive.

Dalia didn’t have a chance to tell Claudien or really anybody about what had happened to her because, not long after her rape, on April 6, 1994, a plane carrying Rwandan President Juvenal Habyarimana, a Hutu, was shot down, commencing one of the bloodiest genocides in recent human history. Over the course of 100 days, while the world looked away, Hutu extremists committed the systematic slaughter of 800,000 Tutsi men, women, children and moderate Hutus.

Life beyond sickness and hunger allows these families to start fresh, from a place of strength, where they can plan their futures, start businesses and lead wholly peaceful lives with a sense of self-confidence. Charles Kayumba, Heifer Rwanda Country Director

The use of rape as a weapon during the 1994 genocide is thought to have played a major role in the spread of the disease and carried a stigma even before the genocide. Victims of rape are often ostracized and seen as unfit to marry. In Rwandan society, a woman’s virginity is of utmost importance. It’s what differentiates the girls from the women and is very closely guarded. A girl can only become a woman within the confines of marriage. It’s how Rwandan women connect themselves to womanhood; many of Rwanda’s sexual crimes survivors often believe they have lost their right to an identity.

As the war progressed, Dalia became more and more reluctant to tell Claudien about the men who raped her, not for fear of retaliation or because she thought he would be angry with her, but because she was afraid he would no longer wish to marry her. “Who would marry a raped woman? They are not marriageable,” Dalia said. Her voice grew soft as she relived the painful memory from 20 years ago.

Despite her fear of rejection, on April 28th, she found her courage. “I said to him, ‘find another bride when the war is over.’ ” Claudien quickly dismissed the idea and took her away from her home and to his village, where they still live today.

Once the fighting ended, people all over Rwanda attempted to resume life as usual, including Dalia and Claudien. They decided the best way to begin anew was to start a family.

“I lost four babies all before the age of one,” Dalia said. “During my fourth pregnancy, I began noticing strange symptoms.”

Aids in Rwanda
Click picture for more information.

That was in 2004, 10 years after she was gang raped. She began noticing extreme weakness, purple marks on her arms and general malaise — more so than during her previous pregnancies. The couple decided to make the trip to the local hospital, though they barely had money for the bus fare. The doctors administered multiple rounds of tests, which cost them a total of $6, a small fortune. Dalia’s test results came back and showed that she was HIV-positive. The results also indicated that her CD4 cell count was dangerously low—a normal CD4 cell count is between 500 to 1,000. Hers was somewhere in the double digits.

CD4 cells help determine your body’s ability to fight off an infection. The lower your cell count, the more susceptible you are to disease. CD4 cells are the key indicator of HIV and AIDS. Once a person’s cell count goes below 200 cells/mm3 in an HIV-positive individual, it means that the disease has progressed to AIDS.

Dalia had AIDS. Further testing proved she had transmitted the disease to Claudien. His CD4 cell count was at 400 cells/mm3, making him HIV-positive.

Dalia was immediately hospitalized. For three weeks, she was under constant (and costly) medical care. “They tried to save my baby from HIV and gave me a tablet that was meant to keep the baby from getting sick,” Dalia recalled, “but it was too late and the child was already with the disease.” When the baby was born, he weighed 6.6 pounds, but he lost weight and strength each day. He was dying, and there was nothing anyone could do. Dalia and Claudien ran out of money, and the hospital staff asked them to leave. Dalia begged bus fare from strangers off the streets of Kigali and went back to Kayonza District with her baby. He died within three months.

“I gave up; I knew my sickness was my death sentence,” Dalia said. They had spent all their money on hospital bills and had nothing left for food, let alone medications. Both Dalia and Claudien were too weak too work, resigning themselves to their fate.

‘This Was Bad’

Soon after, Dalia began coughing up blood and Claudien rushed her to Kigali, where they discovered a Catholic-run hospital that provided free care to people living with HIV/AIDS. She had contracted tuberculosis and had to stay at the hospital for two months. Claudien had a little land in his name that he sold off to pay for transportation costs. There, she began antiretroviral therapy. “I was 30 years old and weighed 62 pounds. I used to dress smart and was always thin but this was bad and made me very sad,” Dalia said.

Dalia stayed at the hospital in Kigali for two years, returning to Kayonza District in 2006. During her stay in Kigali, she had the chance to meet former President Bill Clinton, who was visiting Rwanda with the Clinton Global Initiative. He was there on a mission to open hospitals in rural Rwanda, specifically to provide care to HIV/AIDS patients. She was the sickest she had ever been during his visit. “I shook his hand and begged him to help us.”

Claudien and Dalia
Dalia and her husband, Claudien Mvuyekure, look at old family photos in their living room.

Help came by the name of Partners in Health (PIH) in April 2005, when the organization co-founded by Dr. Paul Farmer launched an ambitious new health program in southeastern rural Rwanda. Modeled after the organization’s work in Haiti, the goal of this project, Inshuti Mu Buzima (meaning Partners in Health in the local language, Kinyarwanda), is to serve as a standard for providing rural comprehensive health and HIV care in Rwanda. PIH started Dalia on antiretroviral therapy.

A year later, in 2006, the medication was working well and Dalia felt healthy enough to try for another child. “We learned that it was possible to have a child born without HIV,” she said. Dalia approached PIH and told them, “I have a life again but no children to share it with.” PIH agreed to help and provided her with powdered milk during her pregnancy. “Because the milk was so expensive, they said that they could only help me have one child.”

Siveta was born later that year, a picture of health, free from the virus that plagues her parents. After Dalia gave birth, her cell count was 370 and she weighed a healthy 132 pounds. Dalia recalled how she felt at that time. “I came back to life. My cell count increased. I started planting crops. I finally believed I wasn’t going to die.”

The Key: Nutrition and Income

But medication is often not enough. The majority of Rwanda’s HIV/AIDS patients are food and income insecure. Both nutrition and income play a vital role in a well-rounded treatment plan. Patients need enough nutrition in order to better absorb the medicine and counteract a common side effect of it: increased appetite. Income is essential to securing an adequate food supply, but many HIV and AIDS patients don’t have the strength for most available jobs in rural Rwanda. Their daily nutritional needs are also high, and they need jobs that are less labor intensive yet still yield a sizable income.

Heifer Rwanda began working in the area in late 2008. In partnership with Partners in Health, Heifer Rwanda’s project, Eastern Province Comprehensive Nutrition & Livelihood Project for Families Impacted by HIV/AIDS, works to improve nutrition and overall net income to HIV and AIDS patients through the provision of goats, training and access to health care.

Dairy goats are easier to keep and care for than cows and are an economical and practical choice to feed and nourish a moderate-sized family. As a bonus, goat milk has the necessary nutrition to meet the demands of those living with HIV/AIDS. The milk is a good source of selenium — an essential trace mineral. While a common mineral deficiency in most people, it can mean life or death for those whose selenium stores are depleted. It’s a necessary ingredient for a properly functioning immune system. Selenium deficiency has been linked to viral diseases, including HIV/AIDS. Adequate selenium stores work to improve T-cell function, preventing viruses from replicating.

“This partnership has helped to move 2,091 families from lives of desperation to lives filled with ambition,” said Heifer Rwanda Country Director Charles Kayumba. “Life beyond sickness and hunger allows these families to start fresh, from a place of strength, where they can plan their futures, start businesses and lead wholly peaceful lives with a sense of self-confidence.”

‘We Rose From Nothing'

Dalia and Claudien with their two daughters
Dalia and Claudien with their two daughters, Siveta and Cynthia.

“When my friends learned I was sick, they left me. I only had Claudien, his family and my mother for support. Everyone else was scared of me,” Dalia said. Her appearance had significantly changed in the few years since her diagnosis: “My nails were ragged and my hair was a mess, people would run away from me. I felt like an animal.”

Whenever she and Claudien had a few coins to buy food from the market, she was always turned away. “They would throw away any food I touched; people thought I would infect them.” It wasn’t until Heifer Rwanda’s work in the Eastern Province led to a partnership with the local Red Cross that things began to change. The Red Cross led HIV/AIDS workshops and sensitivity trainings that helped teach the community that people living with HIV and AIDS are not to be feared and can lead healthy and productive lives.

Dalia and Claudien began working with Heifer Rwanda in 2010 when they received a goat. Dalia and Claudien’s self-esteem grew, and they began to partake in small income generation projects. “Through Heifer, we began to hope.”

About the Project

  • Duration: 2009-2014
  • Area: Southern Kayonza, Kirehe and Ngoma districts in the Eastern province of Rwanda, located about 125 miles southeast of Kigali
  • Farm families served: More than 1,000
  • Goats placed: 1,091 dairy goats and 33 breeding bucks

Each original family received one dairy goat with 33 dairy-breeding bucks placed in convenient locations across the project area. As part of the project, Heifer Rwanda trains project participants on improved livestock management, 12 Cornerstones for Just and Sustainable Development, pasture establishment and management, use of manure as organic fertilizer and vegetable gardening.

The goat they received in January of 2010 was pregnant and had a kid three months later. Her goat went on to have three bucks, which they subsequently sold. The money they received from the third buck was used to purchase a doe, which they passed on in the Heifer tradition. Their goat produces more than three quarts of milk a day, half of it in the morning and half in the evening. The milk is used for home consumption only.

But the goat represented more than milk; she gave them a chance at another child. In 2011, Dalia had another daughter, Cynthia. “Just because we are ill does not mean we do not deserve a decent life.” And, with that sentiment in mind, Dalia and Claudien decided to fi nally make things official; they got married on September 7, 2012.

Building a Business

With community acceptance and improved health, Dalia and Claudien expanded their crop production and diversified their business into selling goat manure to area farmers. In three months, they sold four tons of manure. It’s an easy sell for them because their family farm is home to some of the highest yielding crops in the village, with enough produce left over to sell at their farmer’s market. And others in the community want the same success.

HIV/AIDS was once a death sentence in Rwanda. People living with HIV and AIDS were essentially left to fend for themselves, pariahs of their community. Now, with this initiative between Heifer and PIH, these same formerly disenfranchised individuals live lives never thought possible.

Today, Dalia is a wife, mother and businesswoman. She owns her own livestock and cares for neighborhood children. Her cell count is an impressive 600 cells/mm3 and she maintains a healthy weight of 127 pounds. Claudien, weighing in at 130 pounds, has a lower cell count, at 370 cells/mm3, but he feels well and does much of the family’s crop harvesting. Once a month the couple rides their bike to the nearest district hospital to take their medication. The voyage, round trip, takes them two hours. Like other Heifer project participants in Rwanda, Dalia and Claudien take the initiative to help others living in similar situations within their community. They offer bike passage to those who are too weak to travel to the hospital for their treatment.

Dalia is a genocide survivor and a person living with HIV/AIDS. But she is more than the things she has overcome. She is a woman who lives with dignity and without fear, a survivor in the truest sense of the word.