Zilpa Mukamujema, a 42- year-old mother of five, lives in Gihara, a village 40 minutes’ drive south of Kigali, behind a line of hills in a matrix of undulating dirt roads, small banana plots and sleepy market centres.

Zilpa is not educated. She speaks Kinyarwanda, a limited Kiswahili and neither French nor English. But four years ago, she volunteered as a community health worker.