What started as a routine trip to Kigali, Rwanda, with friends turned into a memorable experience that taught Marcia David, a Seattle lactation consultant, that pregnancy and motherhood in a third-world country is all about courage.

Q.  When you were in Rwanda, you connected with a lactation consultant. How did that come about?
A.  Before I left for Rwanda, I had checked various resources looking to connect with lactation consultants there. The closest I found were in Kenya and South Africa. A few days after I arrived in Kigali, the town where we were staying, I was reading the local English newspaper and found an article about National Breastfeeding Week ,which was happening worldwide in August. In the article, Beryl (the only lactation consultant in Kigali) was quoted. I looked her up and called her at the hospital. She invited me to come meet her and take a tour of the birthing and postpartum unit at King Faisal Hospital, a premier hospital providing services to the more affluent families in Kigali.

Q.  Did you get to assist at all while you were there? Describe your experience.
A.  When they found out that I teach infant massage classes in the U.S., I was asked by Beryl and Dr. Janvier, head of OB at King Faisal, if I would teach a class for them. I agreed. It was very exciting to be so far from home and be invited to teach something that I have such a strong belief in, which brings me such pleasure and which is so beneficial to moms and babies. I came twice to the hospital to teach. Once I taught the nurses and nurse/midwives with a nine-hour old baby boy whose mother so graciously let me give him a full body massage while she looked on. The second time I came, thinking I would be teaching another infant massage class, Dr. Janvier asked if I would help a couple of his new moms with breastfeeding. Once again the moms (and one dad) were so gracious and patient as I explained things to them in English and French, and then had someone translate it all into Kinyarwandan.

Q.  Can  you talk about what the pregnancy/new motherhood experience is like for a woman in Rwanda? 
A.  The women I saw at Rwinkwavu, Dr. Paul Farmer's hospital located in the countryside outside Kigali, were vey poor, mostly HIV/AIDS infected, and not breastfeeding their babies. If they were infected, they were delivering their babies by C-section to protect the babies and were formula feeding to continue this protection. I did two home visits organized by Dr. Farmer's staff and was unprepared for the extreme poverty the women were enduring. Both mothers I met were HIV/AIDS infected, without husbands, and one had been rejected by her family because she was sick. What both women asked for were simple things, like clothes for their children, mosquito nets, and a tarp to cover the mud hut in the rainy season. One of the moms had built her hut herself to house her three children. The gift here is that Dr. Farmer's hospital and staff were providing support for these women and so many more in the form of drugs for their illness, food and other supplies. In all of this, the two mothers' greatest concern was for the care of their children— to keep them healthy and see them educated.

Q.   What was the most significant lesson you took away from the trip?
A.  I was so unprepared for the depth of poverty many of these women were experiencing and the courage they demonstrated.

Q.  What inspired you while you were working in Rwanda?
A.  The women I met were the most inspiring, both those I met at the hospitals and those in the family we lived with. The tragedy of the genocide is still very present. Everyone I met had lost a family member or many family members. So many of the women are infected with HIV/AIDS, living with it and trying to raise healthy children in great poverty. And yet, there is such joy in the singing and dancing and praying that is very much a part of this culture. One Rwandan woman, a writer who lives in Germany, when I asked her how she showed such joy and hopefulness, said, " You must never forget, but you must keep on moving forward." I certainly saw this first hand in Rwanda.

Q.  Has your experience affected how you approach your work back home? How?
A.   I think it has brought a certain sweetness to my work with women and their babies. Just as I saw the love the Rwandan mothers had for their children, so it is here in the U.S. The circumstances are so very different , but in both countries the women take up the challenge of raising healthy children. I love having the opportunity to support them in their choice to begin the process by breastfeeding their babies.