Rwanda Health Journal May 22, 2006

As another entry onto this blog, I would like to first discuss what Rwanda is not so far. It is not a war torn country where you feel your safety is constantly at jeopardy. It is not a military state where innumerable armed guards walk the streets with large guns and intimidating stares. It is not a place where when you arrive, all you feel is despair.

To the contrary, I have been here almost three weeks and so far, the articles and movies I saw about Rwanda did not do justice to the beauty of this country. Prior to coming here I read about genocide and war. Battles between factions that are difficult to fathom. Names of different groups that depending on who wrote the article, seemed either quite specific about who was who, or quite arbitrary. When I told people I was coming here, although I heard it was safe here now, there were many people in the U.S. who looked at me as if I was crazy to really believe that. That I better have my escape bag ready. But then people I knew working here said that the government is stable, that they are working about as transparently as a government can work, and that the organization I am working with in particular, Partners In Health, was impressed by the sincere dedication, commitment, and progressive education of the ministry of health. Meanwhile, most of the people I knew in the U.S. who knew much less about the specific accomplishments of Rwanda today expected danger for me.

Although there is a poverty here that is still shocking to me and that most U.S. citizens will probably never live or witness, no one I knew prior to coming here ever discussed the recent advances and successes of this country like a goal to provide healthcare for all via mutuelles, and to improve education for the whole country; no one discussed the graceful gentle mist that nuzzles into the bushes and mountains most mornings (makes you understand why the movie about Jane Goodall, who did her research in this country, was called Gorillas in the Mist); only one person who had spent much time here spoke of the near perfect climate of about 70-80F everyday, and perhaps most importantly, no one told me about the positive energy and dedication of many inspiring and motivated Rwandans working within the government and for many other organizations and firms to make Rwanda a better country.

And I hesitate to even write this next sentence because it feels not politically correct to even mention such a thing here at this point in Rwandan success, no one I have met at all has ever mentioned the words Hutu or Tutsi ever and when I asked one PIH staff member, she told me that it is taboo to really even use the words in conversation. You really do see many determined, dedicated, involved people at all levels, ministers of health to women’s associations in villages to farmers working together to move forward as a unified whole (Indeed, the only place I saw a definition drawn about the 2 aforementioned groups was at the Genocide memorial this past weekend discussing the historical context of that delineation, and how it was made awfully segregationist by the Belgiums who came here at the turn of the century and decided that if you owned greater than 10 cows you were of one category and if you owned less than 10 cows you were of another category. And as colonials were known to do, the Belgiums created further embarrassing and shameful distinctions, incentives for those they liked and favored, and divisions from there).

But most importantly and very palpable in the air now, at least at Rwinkwavu Hospital, is a unity and a hope I did not expect.

And although the peace here is apparent, more than what many U.S. people might think, the poverty is also great. I did not expect almost all the children I work with in extremely tattered clothes and no shoes. I walk the streets of this rural area and the children yell from far away in the distance, “Mazungo! Mazungo!” which is about the Rwandan equivalent of “Gringo” but said with so much excitement by the kids (although depending on what prefixes you tack on to the word it has the potential to be very insulting). Then children yell “Aga chupa, aga chupa!” which means “Plastic bottle! Plastic bottle!” – because us Mazungos have become associated with plastic bottles and these are very valuable to them. And children also run up to me regularly and ask my name and when I tell them, they most often repeat it as “Roose! Roose!” or “Roosy!” since l’s sound like r’s here. If I try and give them a high five, they put their hand up and we high five, and then more children run up to give a high five too and pretty soon, I am high five-ing a dozen children. Sometimes I put my fist out like a Wonder-Twin cartoon character, and they too will Wonder-Twin power back. And playing with them, even though I do not speak Kinyrwanda, is great fun. I brought my Frisbee and it has been a great success too.

In addition to so many extremely poor children without enough food, clothing or adequate shelter, I did not expect so many children to not be enrolled in school, roaming the roads and fields during the day, using a piece of what some would call garbage to play a game. Even though there are public schools, you still have to be able to afford uniforms, pencils and notebooks, and in the community I live, in Rwinkwavu, the poorest of the poor do not have these things. They have nothing in a way no U.S. citizen lives. The government in Rwanda here, although doing well and advancing as much as possible, is not yet able to pay for consistent electricity or paved roads let alone provide for the social welfare of the poor.

And yet, there is no question that President Kagame aims to improve the status of those living in poverty from many different angles, but income is needed to help others, and this country doesn’t have a huge amount yet. But all this said, as I write, I am sitting on the front patio of where I live at about 6:30AM, looking out onto a gravel driveway with grass and flowering bushes surrounding the driveway. Mist settled around the fence. Beyond this are many banana trees, individually cultivated fields and temperate jungle. All of this stretching in square patches up and down rolling hills like you would see in a Cezanne landscape. I have eaten many tropical fruits which don’t exist in the U.S. from as sweet as a jolly rancher to something like a sour cantaloupe. And so far, if you can afford to grow vegetables, rice, corn and beans, buy sugar and oil, and a family has both a husband and a wife to cultivate their small plots of land, a cement house versus a mud one, a decent latrine, not too many children, and little to no illness, with some means to earn a little bit of money in the markets or some form of employment, then these things combined would allow you to not be poverty stricken anymore. And although there are a seemingly infinite amount of people and patients here who do not have such fortune, for those people who do have this or more, everything is, at least this rich rainy season, flourishing.