Perched atop the terraced hills of Rwanda’s Northern Province, Butaro Health Centre is more than a hospital, it is a haven of safety, compassion, and hope. For countless mothers in Burera District, whose daily journeys trace steep slopes and winding paths, this facility has become a lifeline, a place where fear gives way to reassurance, and the fragile line between life and loss is preserved. ALSO READ: Delivering hope: How Burera’s mothers navigate childbirth in rugged terrain Every day, women travel from distant villages, on foot, motorbikes, and sometimes makeshift stretchers, to reach trained midwives who have transformed childbirth in one of Rwanda’s most remote landscapes. In a region where the journey to care once determined survival, Butaro has become a lifeline. The journey to safe delivery On a misty morning in Burera, Chantal Nyiramahoro, a mother of four, recalls the anxiety that filled her home when labour began unexpectedly. The hills were slippery and the paths treacherous. “The roads were steep and wet. I feared for my baby and for my life. I knew that reaching the hospital quickly was crucial,” she says. With the support of a community health worker, she was transported to Butaro Health Centre in one of the ambulances now operating across the district. Years ago, the same journey would have taken several hours on foot. “Before, we used to rely on people to carry us on local stretchers. Now, help comes fast. We don’t fear as much,” Nyiramahoro adds. For Elizabeth Nyirandikuryayo, another mother who lives deep in the hills, the memory is equally vivid. “The path was exhausting. I didn’t know if I would make it on time, but when I arrived, the nurses were ready for me. They comforted me and guided me through every step until my baby was born,” she recalls. Both women’s experiences echo throughout Burera’s hills; testimonies of a transformation that has turned childbirth from a risky ordeal into a supported, dignified experience. ALSO READ: How Rwanda’s family planning methods transformed maternal, child health A mother’s relief and gratitude When 25-year-old Solange Mukamwiza from Kaniga village, Gastibo sector in the Northern Province arrived at Butaro Health Centre, she was already in agony. Strong contractions gripped her, and the long walk from her home had drained nearly all her strength, leaving her weary but determined. “I was tired and scared when I arrived,” she recalls. “But they received me immediately and treated me so well. The service was excellent. My baby was born safely, and everything went smoothly.” She smiles, happily gazing at her newborn, who is sleeping peacefully. It was her third child, but the first she delivered at a hospital. “My first child I gave birth to at home. The second was born on the road while I was on my way here. This time, I decided I would make it to the hospital, no matter what,” Mukamwiza explains. The experience changed her perspective completely. “I realised how different it is to give birth with professional care. They clean you, support you, explain everything. It’s not like being alone in pain. Here, you feel respected,” she says. Mukamwiza believes many women still give birth at home out of ignorance, not choice. “Some don’t understand the risks. Others live far away or don’t have money for transport,” she explains. She adds with a smile, “But once you come here and see how they care for you, you never want to do it another way. When people treat you kindly, even the pain feels lighter.” Coordination and the referral system Butaro Hospital serves 19 health centres across Burera and neighbouring districts. Its coordination system ensures that mothers in labour, no matter how far, are connected to help. The hospital’s Director General, Dr Eulade Rugengamanzi, says this coordination has been a game-changer. “Before, it could take several hours to transport a mother. Now, with six ambulances strategically placed in the region, most reach us within an hour. That reduction in time has saved countless lives,” Rugengamanzi explains. When complications arise in health centres, community health workers identify high-risk pregnancies and send immediate alerts to the hospital. If a mother goes into labour unexpectedly, the hospital mobilises ambulances or relies on waiting homes, facilities near health centres where women close to delivery can stay under observation. “By combining waiting homes, transport, and community follow-up, we’ve reduced the risks tremendously,” Rugengamanzi adds. The frontline of maternal care Inside the maternity ward, midwives work with calm precision amid the steady rhythm of new life. The department is led by Julienne Niyigena, who has witnessed first-hand how geography and weather shape the hospital’s work. “Mothers sometimes arrive late because of landslides, heavy rains, or long distances. But once they are here, our job is to make sure they are supported both physically and emotionally,” Niyigena explains. Her team’s approach extends beyond clinical procedures. “We use different methods – massage, breathing, movement, even music, to help mothers manage pain and anxiety. Every woman is unique, and we adapt to her needs.” In the neonatal section, Dr. Louis Mujyuwisha keeps watch over premature babies and those born with breathing difficulties. “Premature births and asphyxia are common in rural areas. We respond immediately using simple but effective interventions. Many of these babies would not survive without this level of care,” Mujyuwisha says. The team also follows mothers and infants after discharge, offering home visits, vaccination guidance, and breastfeeding support. “We don’t stop at the hospital door. We continue to walk with them until both mother and baby are thriving,” Dr. Mujyuwisha adds. ALSO READ: How Rwandan ‘virtual hospital’ is changing maternal newborn, healthcare Community health workers: the vital link In a district of steep valleys and scattered settlements, community health workers form the backbone of maternal health. They know every path, every household, and every mother-to-be. Maurice Ahishakiye, who oversees community programmes at the Butaro Health Centre, describes how the system works. “Each community health worker visits homes every month. They identify pregnancies early, follow up on women who miss appointments, and make sure every expectant mother receives care,” Ahishakiye says. When a woman stops attending antenatal clinics, a health worker follows up to find out why. “Sometimes it’s because she’s already pregnant again, or she has moved. They talk to her, remind her of the importance of check-ups, and even accompany her to the clinic,” Ahishakiye adds. He describes how health workers work closely with local volunteer networks known as “imiryango y’ingobyi,” which translates as ‘stretcher groups.’ These community volunteers carry mothers from remote hills to health centres when no transport is available. “If a mother goes into labour at night, the village springs into action. They carry her until the ambulance arrives. It’s an act of solidarity that saves lives,” he adds. Ahishakiye reflects on the changes of the past decade. “Ten years ago, home births were common. Now, almost every woman delivers at a health facility. That’s the result of constant education, community effort, and trust.” Early detection and follow-up In Burera, maternal care begins long before labour. Community health workers track women aged fifteen to forty-nine, ensuring pregnancies are detected early and monitored closely. They follow women through all eight antenatal visits and continue checking in for twenty-eight days after delivery to prevent complications, notes Ahishakiye. This consistent monitoring has greatly improved outcomes for mothers and babies. Complications such as high blood pressure or bleeding are reported immediately, with hospitals coordinated for a rapid response. The programme creates a seamless chain of care from the most remote hills to the referral ward. Beyond medical care, workers also educate mothers on hygiene, nutrition, and the importance of spacing births. “It’s not just about saving lives during delivery; it’s about building healthier families and stronger communities,” notes Ahishakiye. He adds that this approach helps women in even the most isolated communities receive timely, life-saving care. ALSO READ: Elevating midwifery: A transformative journey to reach zero preventable maternal deaths in Rwanda At the gateway of care Before reaching the main hospital, many mothers first pass through the Butaro Health Centre, where initial assessments and stabilisations are carried out. Genevieve Mujawamariya, a nurse there, explains how close coordination with the hospital makes a crucial difference. “We are very near the hospital, so if a woman arrives with complications, we call immediately. They send an ambulance or medical staff right away. We never take chances,” Mujawamariya says. Over the years, Mujawamariya has seen mothers’ attitudes change. “At first, many feared hospitals and preferred home births,” she observed. “Now they come early, remind each other to go to the health centre, and are encouraged when they see others deliver safely.” Daily teamwork and emotional care At Butaro Health Centre, mornings begin with coordination meetings that bring together midwives, nurses, doctors, and psychologists. Each team reviews the previous day’s cases, shares lessons, and discusses how to improve care. “Every birth teaches us something. We analyse what went well, what didn’t, and how to make the next experience better for both the mother and the staff,” Niyigena says. Psychologists are a key part of this system, providing mental health support to mothers who arrive anxious or traumatised. “Some women have lost babies before. We help them heal emotionally and give them strength to face childbirth again. Mental health is part of safe delivery,” Niyigena adds. ALSO READ: Antenatal care key in addressing maternal infant mortality – MOH Overcoming the challenges of geography Burera’s breathtaking hills come with harsh realities. Roads can disappear under heavy rain, and landslides often cut off access to health centres. When this happens, community networks and ambulances work together to reach those in need. “Sometimes an ambulance can’t get through. When that happens, the local stretcher group carries the woman until the road is clear. People don’t wait for help—they become help,” Ahishakiye says. Niyigena adds that education remains an ongoing priority. “Some mothers still come late. They wait until contractions are strong or complications start. We keep visiting villages, reminding them that early care is what saves lives.” Data-driven progress The results speak for themselves. In Burera District, over 99 per cent of deliveries now take place in health facilities. Maternal and neonatal deaths have dropped sharply, and early interventions prevent complications that were once fatal. Niyigena attributes this success to data-driven teamwork. “We review every case, learn from it, and improve. Our coordination and community engagement are our strongest tools.” Digital records track mothers from their first antenatal visit through postnatal follow-ups, ensuring no one is missed. Each name represents a life that is monitored, protected, and celebrated. A model for rural maternal health The achievements of Butaro Hospital have become a model for rural maternal health across Rwanda. The integration of clinical expertise, government support, and community participation shows that distance need not mean danger. Dr. Rugengamanzi puts it simply: “When professional care meets community trust, mothers deliver safely, and babies survive. Even in the remotest hills, safe childbirth is possible.” The hospital trains staff in obstetric emergencies, neonatal resuscitation, and counselling, while collaboration with NGOs and local leaders ensures no mother is overlooked. “Our goal is that no woman dies giving life. Every birth should be safe, dignified, and full of hope,” Rugengamanzi adds. A future built on care For Mukamwiza, that hope is real. “When I look at my baby, I feel thankful. If I had stayed at home, maybe I wouldn’t be here today. They saved both of us.” In the quiet valleys of Burera, Butaro Health Centre and Butaro Hospital tell a story of transformation – saving lives, strengthening communities, and giving every mother, no matter how remote her village, the confidence to give birth safely.
