11/20/06: Arrive in Rwanda today after nearly missing my JFK flight due to an over-sleeping car-service driver and his narcoleptic dispatcher.

Get to JFK fifteen minutes before departure time.  Sprint to ticket-counter and beg my way to the front where I wait to collect my ticket from an agent who informs that my baggage and/or myself may miss the flight.  Sprint to the security checkpoint, beg my way past several hundred qued passengers and encounter a security officer who informs that if I refuse to have my thirty boxes of Super8mm film x-rayed they will instead need to be individually opened and hand inspected.  Panicked beyond measure that I’m missing my flight, I have him send the film through the machine and hope for the best.  I follow this with a ten-minute sprint to my gate where the ticket woman tells me to stop and breath and compose myself.  I am the last to board.  The door closes behind me.  A sweating mess but at least I’m on my way to Rwanda.

I fly Ethiopian Air from NYC to DC to Rome to Addis Ababa to Nairobi to Kigali…23 hours of sleep-deprived torture for $1,788.00 roundtrip.  I’m scheduled to return in six-months time but perhaps I’ll stay longer, who knows.

11/21/06: A day later I’m finally flying into Kigali airport and peering down at a group of men cutting grass with machetes.  Eleven years ago the genocide was ignited when President Habyarimana’s plane was blown out of this exact same patch of sky.     
In Kigali, after collecting groceries, blank CDs, and plastic page protectors Laura and I depart later than anticipated and get caught driving to Ruhengeri in the dark; a dangerous activity in Africa’s most densely populated region.  The absence of street lights grow increasingly pronounced as our headlights begin flickering over swarms of trudging figures which vanish off to either side as Laura slaloms the LandCruiser along a crater-filled lane and onwards through this half-seen gauntlet of plodding feet, whirring bicycles, and bowed heads beneath sacks, buckets, grasses, and timbers.  We reach home and collapse into bed.

11/22/06: My first day at the Clinic.  Unsure what to expect.  I shoot little.  Not looking to shove my camera into anyone’s face - not ‘til I make a few friends.  Hoping to ease my way into this community.

Visiting doctor, Peter, has an intense day that begins with the delivery to the clinic of a park ranger who got caught between two competing Silverback gorillas…one of which used him as a teething toy.  Dr. Peter examines the man’s scrapes and bruises and diagnoses a possible separated shoulder.  No x-ray machine at the clinic (and no electricity with which to power one) so the man is referred off to Ruhengeri hospital where such luxuries exist.

A sizeable satellite dish sits incongruously in the clinic yard, linked to a phone inside, and powered by a rooftop solar panel; it’s the only working phone in the surrounding countryside and yet has been inoperable for months due to an exhausted supply of phone-cards and no money for more.  I'm told that this sort of “small missing link” which condemns an otherwise well built system to failure is not unusual here.

The clinic is a study in bare necessity.  Sanitation and hygiene are non-existent, as are scalpels and sterilization.  The visiting doctor drains puss from a women’s wound through creative use of a straight razor soaked in iodine.  The two patient wards are rank, dirty, and bare: four dirt-caked walls housing eight bed-frames covered with the thinnest of torn stain-spattered mattresses.  No sheets, no pillows, no blankets. Patients wrap themselves in whatever they bring.  The windows, due to a lack of curtains, have been painted over with brown paint; scant light filters in.  No food: Patients who do not have a family member to bring them something get nothing to eat.  No systematic medical rounds: sick patients and newborn babies are left unattended for hours at a time.  Sick patients and newborn babies are also hospitalized side by side in the same room.  The weather here is cold, damp, and miserable.  This is not a place in which to recover from sickness.

Jacqueline and Laura have initiated a campaign to fight back.  Today, Laura brings several jugs of bleach and a paint scraper that I’ve brought from New York.  Tomorrow we see who in the community will aid in this effort to take a bite out of grime.  Community participation will make or break this project: CCHIPS may leave this clinic behind in 2 or 3 years time and thereafter it will be up to the community to sustain and continue the progress.

The clinic’s toilet is repulsive.  A small thatched shack, it sits behind the clinic and exudes a stench that moves one backwards and away.  Built over a pit, the shack has a floor of uneven logs with no designated hole to crap in.  Those who enter aim at various cracks in the flooring.  Different users aim for different cracks.  The results are grossly unhygienic.  Sticking my head in, I eyeball a pile of human feces gracing center stage and retreat.  Someone has poor aim.

Nurse Elman jumps into the back of the Land Cruiser and flips open a pocket-sized photo album to reveal a picture of his “first family”.  The photo looks recent - Elman standing with wife and kids - all of whom, he murmers, were killed in the genocide.   Later we learn his wife and children were hiding in a nearby cave with other refugees.  Those who tried to leave were murdered.  Those who remained died of dehydration.  Elman’s family remained.  I don’t ask how he survived.

Everyone in this country has lost too much.  People here speak of lost ones too mater-of-factly.  When surrounded by such pervasive horror does its commonplaceness render it less devastating or more?  There is a huge need for mental health assistance here - virtually none exists.  Rwandans keep tremendous emotion bottled up inside.  These demons are etched in the lines of their faces and peer out from the backs of their eyes.  Now Elman has a second family and seems a happy man eager to get ahead.  We sit together exchanging English and Kinyarwanda vocabulary.  Extracting pen and notepad he waves both in the air exclaiming with a grin, “like a Muzungo (foreigner)” and we begin studying together.

Included among today’s novelties are several unopened boxes of de-worming medication donated by Pfizer…all were supposed to have been dispersed to the local population without charge…yet these boxes haven’t been opened and some now show past-due expiration dates.  Later, we learn that of the medication that had been dispersed some was sold rather than given away.  Laura bites her lip.  

11/23/06: Today begins well and ends with one severe injury and one death.
Several community members arrive in the morning to help lug beds from the clinic’s two patient wards in preparation for Laura’s imminent cleaning campaign.  Today’s goal is to clean the walls of one of the wards in preparation for next week’s painting.  Laura leads the effort armed with several bottles of bleach.  Everyone, it seems, works harder when a Mazungo sets the pace - a condition Laura finds frustrating yet at day’s end she’s delighted with the results (whitewashed walls) and paces back and forth between the wards exclaiming her joy.  Five hours of work and years of dirt, grime, and muck are scoured off the walls.  The improvement is remarkable…and remarkably inexpensive and quick…why haven’t the locals been doing this all along?

My day begins surrounded by curious locals.  Cameras fascinate people here, as do we Mazungos.  An hour passes during which locals surround me, asking for their photo and group-giggling at the results.  One boy asks me to photograph his Mother and Father.  Obliging, I display the results on my camera’s LCD only to have him exclaim that they look too serious and he immediately commissions a new round of photos, this time with the desired facial arrangements.  A local nurse, Emmanual, appears, and I spend some time teaching him to operate the video camera, cringing somewhat as he rolls twenty-minutes of skewed unfocused footage…but he’s improving towards the end and I promise more lessons.

One must be forgiven for expecting Rwanda to be HOT…lying as it does smack-dab in equatorial Africa.  This, however, is NOT the case in the mountainous northwest part of the country.  Ringed by dormant volcanoes and perpetually besieged by rolling masses of clouds, Bisate sits at over 8,000-ft elevation and bright warm mornings here yield quickly to gray cold rainy afternoons.  The clinic has no source of heating.  Today is frigid and miserable.  Patients lie in beds fully clothed and wrapped in whatever can be found.

At noon, Laura enters the Maternal Ward where a new mother invites her to look at her baby.  The newborn is swaddled in a blanket which the mother withdraws as Laura leans over to coo the requisite “beautiful, beautiful” in Kinyarwandan - only to find herself staring at a tiny face that has turned blue.  The nurses attempt to revive the infant but it gasps and dies.  Nobody can say why.  No one has checked on the baby in hours.  Laura is shaken.  The rest of the day is tense and tiring.  There are many patients.  The dead child is on everyone’s mind.  Exhaustion sets in.

On the way home from this chaotic depressing day we pass an SUV turned sideways and lying in a ditch, windshield splintered.  We’re told the vehicle flipped completely and a British woman has been taken to hospital with head injuries.  We continue homewards, stopping along the way to drop-off the dozen Rwandans who’ve hitched a ride back with us from the clinic.

At home, on the verge of unwinding and enjoying a warm meal, Laura receives a call from Glen, the local British Embassy Warden, phoning in search of Dr. Peter.  The woman in the accident isn’t comfortable with the local doctors and has requested a Western counterpart.  A touchy political situation and so Dr. Peter phones Felix, head of Ruhengeri hospital, for official permission to see the patient.  Hours later Dr. Peter returns to report that the lady is cognizant and seemingly okay but worried that fluid leaking from one ear might be spinal…he has advised she be airlifted to a hospital better equipped to deal with head injuries.  The woman is medevaked to Nairobi the following day.  We later hear that she had indeed suffered a skull fracture.

The roads here are rutted, potted, thronged with pedestrians, and covered with horrible drivers who take constant risks.  We haven’t experienced a single ride from Ruhengeri to Kigali or back that hasn’t passed at least one major accident: tanker-truck on its back, dump-truck smashed face-first into rock wall.  The road winds perpetually back and forth around tight corners and steep hills surround on all sides.  You cannot see more than fifty-feet ahead to the next bend and yet drivers constantly pass us in the on-coming traffic lane even while rounding sharp blind curves.

A rough evening; all we desire is food and sleep.  However, the nano-water filter is broken so we spend an hour taking it apart and reaffixing without success.  Nano-technology is amazing but something has affected the outflow; it has become just a painfully slow trickle.  I spend an hour pumping this trickle into a 20-Liter jerry can for delivery to the Clinic.   
One bright note: the DVD I brought for Gabby is a huge hit.  He now spends all waking hours quoting and mimicking lines from that fabulous American contribution to the world: “Dumb & Dumber”.   Also brought another film that has succeeded in giving him nightmares for a week, “Van Helsing”.

11/24/06: Videotaped Roz Carr’s memorial service today.  Our friend Glen loans me a suit and shoes for the occasion and we drive up to Roz’s spectacular 100-acre flower plantation which is now the site of the orphanage she created for hundreds of the genocide’s youngest victims.  It is a magical place of indescribable beauty and greenery encircled by a horizon of encroaching volcanoes; a trip into Middle Earth.  The road is horribly cratered however and we bump along violently and soon pass the obligatory broken-down vehicle.  Being tossed about in a vehicle like this while traversing a riverbed road has a name: The African Massage.  Roz’s house finally comes into view, just as remembered, lush front garden gracing a house whose walls and roofs are covered from head to toe by a thick green hedge; a Hobbit hut.   
Three years ago nearly to the day I departed this same plantation thinking I’d never see it again and now a feeling of bittersweet nostalgia tempers my reunion - had I been just two months earlier I might have seen the great lady once again; now it’s too late.  It is wonderful to see the familiar faces of her orphans.  They’ve become teenagers in my absence and no doubt someone must now be dealing with the Mother of All  unenviable supervisory situations.

The American Ambassador gives a particularly emotional eulogy followed by a group of young singing orphans whom I remember too well.  The children are singing the same song they sang those three years ago – then back at the old Gisenyi Orphanage while surrounding Roz in their little outdoor clubhouse.  She had clapped along and those old eyes of hers had beamed with a radiant youthful joy.  ‘You bring joy, joy, joy, joy, joy to my heart / Joy to my heart / Oh joy to my heart…’ The song smacks me in the heart.  The times have changed.  A great lady has died.  Orphans that have seen unimaginable horrors are singing and I learn that it’s difficult to videotape while wiping away tears.

The rains are relentless this week.  A friend of Glen’s is driving to Ruhengeri when he spies a pair of tiny hands flailing above the rim of a roadside gutter, a torrential gush of water is washing their owner down the drain.  Gunning the engine, the man speeds ahead at 40 Km/hr for a quarter mile, jumps out, and hauls the small boy to safety moments before imminent drowning.  Despite the heroic rescue we later learn that the boy died some days later.      
    
11/25/06: Today I meet a man at the Clinic.  John has come looking for work and delivers his CV to my sister.  He speaks four languages, has a secondary-school degree and a bulk of experience…yet can’t find a job.  John has five kids.  Everyone here has five kids.  Aside from the park and the clinic there are no jobs.
 
At dinner, Laura tells our cook Gabby that she has eye-glasses in her eyes.  Gabby looks back in disbelief expecting a punch-line and gasps in amazement when she extracts a contact lens for his inspection.

Our damn dog is eating us out of house and home: chewed through Laura’s cell-phone charger (which means no internet until our next trip to Kigali in a week or so)…damn dog also chewed through a pair of shoes I’m borrowing than shat on the floor and has started biting everyone.

Memorable quote of the day: “you’ve got to fuck with the dick you’ve got”.

11/26/06: Monster Dog chews through one of Laura’s flip-flops and my borrowed dress shoes and then Gabby’s telephone charger – Gabby buys a new charger and Monster Dog chews through that too before breaking into the hen house and devouring eight eggs.   I spend an hour with Dr. Peter re-wiring Laura’s cell phone charger.  While we’re preoccupied, Monster Dog chews a hole through my new shirt and takes a dump on the dinning room floor into which Dr. Peter steps exactly as we’re sitting down to Thanksgiving meal.  Monster Dog is banned from entering the house.  
Rested and organized myself today.  Gabby’s day off, so we make lunch and dinner for ourselves - rather Laura and Eamonn make lunch and dinner for the rest of us.

Organized, organized, organized…tried to digitize footage today but ran into an endless series of problems…digitized the same tape four times with no luck…either imported at 29.97 or the plug fell out or the electricity went off or whatnot!  Aggravating!

11/28/06: Yesterday and today I follow our visiting doctor on his rounds - patient examinations and consultations.  In a bed lies a sick man who can’t speak, can’t focus his eyes, refuses to take drugs, has torn the IV out of his arm.  He moans all day long.  Dr. Peter says the man is too sick for here, the Clinic’s resources too limited to treat him.  He says the man needs to be transferred to Ruhengeri hospital for blood tests.  Jacqueline, the Clinic’s head nurse cannot or will not transfer him however.  The man has no mutuelle (no insurance) and apparently cannot therefore be transferred.  Mutuelle costs $2 per year.  This man couldn’t afford this.  He became sick and didn’t come to the clinic right away.  He stayed home a long time…perhaps too long.  I think he’s dying.

Among the other patients is a young girl, Angelique - attractive and very sick.  18 years old.  She’s been here a week with a high-temperature.  Malaria is suspected.  The clinic’s lab tech is away and so no tests can be performed to positively identify the disease.  Her current medication doesn’t seem to be working; they’re planning to try another soon.

On the ride from Ruhengeri to Bisate Clinic, we pass a State-organized protest of France.  Yesterday, a French Court found current President Kigami’s military chiefs responsible for blowing former President Habyarimana’s plane out of the sky in 1994 (thereby jumpstarting the ensuing genocide of 800,000 Rwandans).  President Kigame’s response to this indictment is to throw everything French out of Rwanda; French nationals have 72 hours to vacate the country, the Ambassador has 24 hours to scram.  Projects funded by French money have a day to close.   

12/1/06: A day that shall forever live in infamy - I shit myself.  Badly.  First time in my life and it happens in a car-full of people.  I ruin my only pair of pants along with a pair of precious underwear and two socks…all now are decaying at the bottom of the filthiest outhouse in Rwanda: a tiny mud box with it’s door lying on the ground and the smallest of holes gracing an otherwise crap-strewn mud floor.

The trip starts with a stay at a sketchy hotel near Akagera Park.  Only option for our late dinner is the hotel buffet, which in hindsight may have been sitting out for some time.  I eat a lot.  The spaghetti tastes strange.  Laura, Peter, and I spend 15,000 franks each ($30) for the nicest rooms in the place after making the Manager promise that there will be hot shower water in the morning.  Morning arrives there is no hot water or cold water.  My shower doesn’t work at all - welcome to Rwanda.  Rwandans can build walls and roofs but when it comes to plumbing the results I’ve encountered are uniformly disturbing.  The day begins on the wrong foot.

We spend three lovely morning hours in Akagera Park where Giraffes and Zebras amble past the LandCruiser followed by water buffalo, hippos, impalas, and then we halt to view a large flock of vulture-like birds.  One wide-eyed look from Eli and a shriek from Gabby are all that precede a mass of fur that suddenly launches at the vehicle.  For an instant there is a long hairy arm sticking through the open window lifting our bag of croissants before dropping it for our bag of bananas.  Thereafter, a very large baboon proceeds to sit down three feet away from us and consume our fruit, peel and all.  Afterwards, it leaps onto the hood of our truck and sits staring blandly at Dr. Peter and Laura for several minutes.

Everything continues to go rather well until we leave the park and are 30-minutes on our back to Kigali airport where Dr. Peter won’t have much time to catch his departing flight.  It’s at this juncture that someone realizes Jean-Babtist’s wheelchair has been left back at the Akagera Park Office (it was left to clear space in the LandCrusier for animal viewing and we neglected to collect it on our way out…how Jean-Baptiste failed to notice that his main mode of transportation was being left behind is a question best left to Jean-Baptiste).  Laura is on the verge of saying tough toenails and continuing on to the airport…but it’s Jean-Baptiste’s wheelchair – so we turn around and head back for it.

Rather than continue onwards with a detailed account of my ensuing bowel tragedy and the insanity that ensued thereafter I will instead leave this quote:

The door opened onto the street and the smell thereof.  The mosquitoes were competing with the flies and losing.  I lay on the boards, a foot off the floor, and said in the darkness, ‘I wish to die’.
        - Martha Gellhorn (Travels with Myself and Another)

12/2/06: A much needed day of tranquility and mending, I do nothing.  Go to bed, the cat curled up in my armpit with just her little head sticking out onto the side of my chest…adorable little creature.

12/3/06: Back to the Clinic to commence painting.  Day begins in panic as we go to buy a special sort of petrol oil required for the painting (they mix it with paint here) only to discover that everything is closed, it being Sunday and all.  After a good bit of scampering about and back-alley dealing, however, a jerry can of the stuff is procured and we’re off to the clinic.

Painting day.  A big step.  CCHIPS has hired three local ‘professionals’ to supervise several community volunteers.  One of Laura’ coveted rules is that all work funded by CCHIPS must include community-provided-volunteers who are there to assist in the work’s completion.  Sis and Eamonn inspect the progress intermittently all day long and are more than a little critical….but at day’s end Laura is again agog with joyful pleasure at the remarkable transformation that is fast turning these dismal chambers into clean spaces.

Laura and Jacqueline discussed the new patient/ward layout options.  Their conversation is becoming a familiar one – one they’ve now been having for several days.  The plan Laura wishes to enact is to finally separate mothers and newborns from the sick. In the past and presently they are all bedded beside one another in the same room despite the obvious dangers.  Laura wishes to use one of the two ward rooms exclusively as maternity and the other exclusively for the sick.  The conversation is becoming a frustrating one however as they keep seeming to agree on Laura’s plan and yet soon thereafter Jacqueline will add that it is more important to separate men from the women – a plan that would therefore place sick people and babies back together once again.  Laura constantly replies that 95% of the patients here are women and that with so few men coming to the clinic it makes no sense to give them half the clinic’s limited space (there are only two rooms).  Laura says she’ll have a divider made for the sick room to separate the sexes.  Unsure if Jacqueline is fully onboard yet.

A man arrives to check the leaking roof - large wet rotting patches can be seen in the ceiling.        
The old man who was sick here last week, the one who couldn’t be transferred due to a lack of insurance, died yesterday.  I am currently logging footage of him writhing in pain on his bed.  It’s an ethical dilemma to be filming the misery of a dying human being but this problem I think should pale in comparison to the moral question of why the man died the way he did.  No $2 Mutuelle.

Got some great film footage at the house today of the surrounding mountains ringed with clouds at sunset…hoping my journey-starting airport fiasco hasn’t fogged my 8mm film stock.

Eamonn makes soup for dinner.  Gabby watches movies endlessly in his room.  I send and answer emails.

12/4/06: We find a boy waiting for us at the clinic with a temperature of 104.  He seems dazed and needs help walking.  His case is severe and he has been referred to Ruhengeri Hospital for treatment.  After the referral was given, however, the boy and his mother continue sitting at the Clinic for half the day waiting for us to arrive.  The ambulance to Ruhengeri hospital is too expensive.  At US$14, the 10.5-mile ambulance ride would likely cost the family more than it earns in a month, quite likely two months.  Eli diplomatically tells Laura about their hope.  Laura is concerned about becoming the local ambulance service but what can you do, we take the sick boy to Ruhengeri hospital.

Next day we learn more.  The sick kid can’t be more than fifteen but the story is that he impregnated a girl younger than himself who, after giving birth, attempted to secretly bury the newborn alive in a field.  Miraculously someone saw her and dug up the still-breathing baby.  All involved are now at the police station or hospital.  

12/7/06: We arrive today to find a boy lying face down and stock-still upon the clinic’s side lawn.  It appears he has been lying like this for some time.  Laura yells for someone to take him to a bed, explaining that the clinic can’t have injured people lying unattended on the front lawn - bad for the image and all that.  A nurse explains the boy has been severely beaten and is lying there waiting for those who beat him to come pay for his hospitalization.  This is how it work here – if you hurt someone you also pay their hospital bill.  

The drive to the clinic consisted of a torturous hour over a bumpy potted stretch of dirt and boulders the month before my arrival.  More recently however things have changed for the smoother.  The Chinese have been hired to build a new road and they are quickly doing precisely that.  The trip to the clinic has been cut to thirty minutes.  However the ongoing construction means the road is often closed and we’re frequently forced on detours that take us through fantastically beautiful stretches of Rwanda countryside and over roads that relentlessly beat the crap out of us and our LandCruiser.  Flat tires are legion.  African Massages rule the roost.

Today we have men come up to do assessments of incinerator & latrines.  At night Nando shows up, a mad Spaniard who is biking around the world and has already been on the road two years.  He has contracted Malaria very recently and we find him in bad shape – but still determined to keep cycling ahead.  His only weapon is a large machete.  He has come today from Goma where a soldier pointed his AK47 at Nando, cocked it, and demanded money.  Nando was hustles away to safety by some locals.  

12/11/06: It’s morning.  Laura, Eli and Jacqueline are sitting around the breakfast table going over the Clinic’s financial figures…which are still a mess but appear to be improving.  The statistics kept under the old manager, Ali, are universally suspect, wrong, even ridiculous.

An old man comes to the clinic today covered in blood.  Someone has thrown a rock and near taken his head off…beginning to suspect that a considerable amount of banana-beer drinking occurs locally.

12/12/06: Last night a man was machine-gunned in the nearby Kisate district, which we drive through each day - shot nine times.  The murderer got away and the countryside is up in arms.  We pass a large military platoon on our way to the clinic and among the standard AK47s I spy an impressive arsenal of mortars, bazookas, and heavy caliber guns.

Vaccination day at the clinic.  Never have I head so many screaming babies…each is made to endure an injection, an oral vaccination, and a blood test… today many babies voice their displeasure with life.

12/13/06: Stayed home today.  Finished the web-page outline with Eamonn.  Tried sending it to Ro & Peter with no success.  Laura and Eamonn currently like www.bebetter.org for our web address name.  I think its sort of a weeney-type name.  Did my usual 40-minute morning jog and ended up racing a little kid who was hauling a 20-liter jerrycan of water.  I barely won.

12/14/06: Gabby went to bed ill and awakes convinced he’s suffering a bout of cerebral malaria – we drop him at the Ruhengeri clinic and continue up to the clinic for a day of upgrade supervision and round-table discussion between Laura, Innocent, Jacqueline, Jean-Pierre, and Eli…  Returning later, we hear the docs could find no Malaria in Gabby – I think he’s dehydrated and suggest a sizeable ingestion of water.  The next day he feels better.

12/15/06: Went to bed late and woke up in a less than stellar mood…which was lessened still further by the discovery that all three toilets in the house are clogged and out-of-operation.  Laura starts giving me a repeat sermon on not washing toilet-paper down the toilets.  And, rather than point out the non-existence of waste bins in which to dispose of said toilet-paper, I instead turn my back and walk off in a huff.  Later on, still in a shabby mood, I make yogurt using our yogotherm: fresh yogurt the last thing standing between me and insanity.  The milk is delivered each morning still warm from the cow.  Give me two liters of the stuff and I can make the best damn yogurt you ever tasted.

In a poor mood throughout the day, so asked Gabby to teach me to make bread…which he did in a fashion…though we never did get the darn dough to rise…and I felt slightly better for it – dough’s in a bad mood too.  Felt better after christening each loaf with a string of dough in the shape of an S.  Sean Bread I call it.  

12/16/06: Went to bed early and woke early, logged a half-hour jog and then digitized three tapes before 11:30am!  An impressive start to the day.  Laura and Eamonn have left to spend the weekend together in Kigali – they will collect the bio-gas expert, Mike, on their way home Monday evening.

Monster dog is improving somewhat!  Was actually cute for a split second today.  Still thinking about project names for the website….thinking “One Clinic” might be nice – www.oneclinic.org.  Probably taken.  Or perhaps www.risingclinic.com?

12/17/06: Beware of doing favors.  A researcher for the Diane Fossey Fund, Veronica, asks me to dog-sit for her and I end up spending the night looking after two devil dogs while she heads off to have a good time in Kigali.  Damn spoiled dogs have the run of the house…pound their way through the bedroom door, jump through the damn mosquito netting, drag fricken women’s underwear all over the house.  I wake at 6am to let them out and they’ve pissed and shitted EVERYWHERE!  The house is a minefield.  Thankful to exit the next day - the experience is draining.  

12/18/06: Computer is broken again (bastard won’t boot in regular OS X).  Something about a “Kernal Panic” which I read is related to a snafu in the core operating system.  Currently the only access to my desktop is thru “safe mode”, which allows me inside but disables all my toys, aka my FCP video edit system.  Disgusted, I bake more bread today with Gabby…damn dough still refuses to rise!  Maybe the visiting engineer, Mike, will be able to help.  It’s delicious bread but we need to get it upwardly mobile.

Started Paul Farmer’s book “Pathologies of Power”, eye opening, especially given my current position.  He posits questions about mainstream attitudes towards third-world health that compel one to re-examine ones pre-conceptions…unsettling stuff.  

12/19/06: Eli breaks the news that the young female patient, Angelique, has just died.  An attractive girl who, last I saw, was seemingly in the process of regaining her full health.  Eli reports she went to a traditional healer for treatment and was likely poisoned to death by whatever she was given.  Death is not presented as shocking news here.  Poisoning, I am learning, is blamed for a healthy percentage of sickness and death in Rwanda.  Apparently Rwandans are paranoid about being poisoned by their neighbors.

I would like to know what the death rate is here.  I’d also like to spend more time with patients.  I know of three people who have died at the clinic since my arrival: a man, a baby, and now this young woman.

12/20/06: Déjà vu.  Yesterday we rushed out the door because the director of Ruhengeri Hospital called early to report that the Aquasan people were here NOW, a day early, and ready to go up to the clinic this minute!  
We reach Bisate today and drive thru the largest crowd I’ve ever seen up here.  An investigation is underway - a man has reportedly raped a young girl – and now every town member is bearing close witness to the ongoing investigation.  

Internet is maddeningly mind-numbingly slow.

Terrible accident yesterday.  Boscos’ wife and kid were riding in the pack of a pickup truck that flipped; Kid’s undergoing surgery on two broken arms.  Wife’s undergoing surgery on her head.

12/21/06: Had our Christmas Party today up at the clinic.  The goat was selected yesterday and killed this morning, then cut up and boiled in a pot on the ground over an open fire.  Mutzig and Primus flowed like water, a refreshing respite from many days of endless rushing.  Met a great many people…all the Nurses and employees brought wife and kids…Rwandans sure do dress nice…would put to shame us slobs in the Western World.  For the first time it seemed everyone was rather comfortable with each other.

I got hit up to shoot a Rwandan music video by our local wiz-kid environmental health professional/scholar-student, Jean-Pierre…so we’ll see how that goes.

Have been trying to order a new computer over the internet these past two days without any luck – only access is with Laura’s cell phone and the speed is ridiculously slow…so today we stopped at the Diana Fossey office and used their high-speeds to buy a new 17’ powermac ($3,000 with case and apple insurance).

The day concluded with our second flat tire in as many days.

I still feel sick.  Mike the engineer feels sick.  Gabby feels sick.  Whoa is us.

12/31/06: We celebrate a Rwandan New Years over a homemade Chinese meal at the house of Simon, Winnie, and Veronica: European Scientists working for The Dian Fossey Gorilla Fund.  While dining, we watch 'Pirates of the Carribeen II': a brain-ruination machine that everyone everywhere worldwide adores like the Second Coming.  Last year, I worked the 'Pirates II Red Carpet Premier at Disney Land' and witnessed this celluloidal cow-pie of a flick drop into our universe to the wail of sousaphones…but that's another story altogether.  Anyways, after two and a half hours of piratical torture, our Rwandan New Years celebration totters back to its feet when the Europeans decided to screen something 'more European' which entails a video of a giraffe, a sizeable electric anal prod, two guys with a ladder, and a tsunami of giraffe semen engulfing an elderly female bystander.

For a nightcap, we watch a Bill Hicks comedy routine 'til 1:00am (pausing for the usual 12-midnight nonsense).  Funny guy, Bill.  I'm told that he died recently.

Everything in this country has a price tag, even friendship, in fact especially friendship.  Disconcerting to know that on a daily basis 99% of the people I make eye contact with are interested in me for precisely one reason…handouts.  Every white person here is 'Muzungo': a rich white person.  The only local 'raison d'etre' for Muzungos is to serve as givers of handouts.  This jilted atmosphere unfortunately incites me to act perpetually stand-offish towards every person I encounter while at the same time it plagues me with guilt for acting rudely towards persons who haven't yet asked me for anything (I know it's coming though).

New York City has its share of beggars.  If you're like me, sometimes you give and sometimes (most times) you don't.  However, in this region of Rwanda (where tourists throng to see Mountain Gorillas) the begging is different…it's not perceived as begging, rather it's standardized routine behavior that is promoted by the general population and carried-out by the children with an unabashed sense of blind entitlement and belligerent expectation.  Foreigners exist only to distribute money, bottles, pens, cell phones, English lessons, you name it.  Describing this attitude without sounding like a cold Western ass is difficult.  This is a poor country.  The people are often cold, wet, sick, and hungry, and there's little they can do about it.  By western standards, the population of Bisate is impoverished.  However, there's enough to eat and the people do not consider themselves impoverished, this is normal life.

And despite what liberal communist naysayers say, America looks good, from afar.  We enjoy freedoms denied to countless others.  In Rwanda, for example, everyone is REQUIRED to participate in certain social activities.  You must attend state-sponsored parades and soldiers go door-to-door to ensure participation.  Everyone is required to attend the local one-day-a-week genocidal 'Gachacha' court systems.  When you vote in 'an election' someone stands beside you to ensure that your thumb marks the correct candidate.  This is not the case in the U.S.  Sure, the U.S is a far cry from the country it should be.  We have a decent legal system and decent human rights legislation but our healthcare and welfare systems are despicable…Cuba bests us in important global categories.  We neglect, marginalize, and forget the poor in the USA and hide this act behind a veneer of politically correct (whatever that means) slogans that nealry always mean the opposite of what they mean literally.

 
1/01/07: Today, I shoot more of this zero-budget Rwanda music video for Jean-Beaufort, a new acquaintance/artist/beer-brewing scientist/and now first-time music video director.

The weather is precarious: alternating back-and-forth in mere minutes between sun, clouds, and torrential down-pores.  We deploy an old rickety bicycle with one flat tire as our dolly, atop which I perch wobblingly and attempt to film a marching hoard of singing kids.  Two assistants attempt to keep the bike upright and rolling but I topple about like a drunken sailor upon a stormy sea.  Jean-Peter, my overly rationalistic friend, tries placing me instead in a rusted-out wheel-barrel but the results are similar.  Amateur-hour reigns. Thereafter, I waste two more hours attempting to do eye morphs of video dancers: a process wherein clear plastic tape is placed over the camera LCD screen upon which is traced the first singers' eyes.  The camera then remains absolutely motionless while the eyes of all subsequent video dancers are lined-up exactly with this tracing.  If done correctly, one may create (in post-production) cool-looking fades/morphs from one singer to the next in which heads morph from one singer to another while eyes remain constant.  Our singers, however, cannot keep their flimsy heads from lolling all over the place and so these efforts too are wasted.  I watch the camera like a hawk lest one of the many milling children latches onto it, something that they seem wont to do.

Today is spent lounging on the porch cursing the dog.  MonsterDog murdered one of our three chickens last night.  Eamonn buries the remains, those that can be found, under a rock, yet Monster Dog has hidden away various bits and pieces for future nibbles.  All day I curse the beast in an effort to make it stop gnawing on these ill-gotten gory gains and to make it stop from generally gnawing on everything in sight…chairs, beds, people, my feet, used toilet-paper...you name it! 

Eamonn's trek up Africa's second tallest peak (Karisimbi Volcano) is cancelled last minute and rescheduled for tomorrow. I think this brings a sigh of relief as Eamonn is still attempting to determine how exactly to erect his rubic-cube of a camping tent. On Friday my new computer will arrive with a visiting group of water-quality-investigating MIT students.  Spoke with brother Kev and sister Tash tonight: they are trying to unravel the unfathomable mystery behind arranging my new Pelican computer case's pick-n-pluck foam - no doubt screwing-up everything - got my fingers crossed.

 
1/02/07: Town meeting today with the CCHIPS house staff to get thing sorted before these five MIT visitors descend upon us.  I type a list of House Rules for the incoming hoard.  One must have rules.  Organized and civil society must be preserved.

1/03/07: A break-through day:  I conduct my first staff interview with Nurse Emannual, a man who greets me every morning with a wide smile and a "SEAN!!  Ca Va?"  For the remainder of the day, he will shout "SEAN!!  Ca Va?" each time that he sees me.  This happens on a daily basis.  The repetition of "SEAN!! Ca Va??" becomes nerve-wearing on occasion, especially on days when I hear it over a dozen times but I do like Emannual and therefore if he is always-and-forever going to be perpetually shocked and delighted to see me, so be it.  He is the only staff member who is present at the clinic WHENEVER we arrive.  This is a good thing.  Emannual is not an actual 'nurse', as he never attended high-school and is therefore officialy classified as a 'Health Worker'.  We call him 'Nurse Emannual' because he seems to be the only person here who actually tends to the patients.  As a Health Worker he is paid the lowest salary of anyone on the medical staff (about $0.72 per day).  I listen to him speak with patients while he bandages their wounds, he talks to them about how to better care for themselves, more than anyone else, Emannual enjoys the human contact aspect of his job; helping the hurt and sick comes naturally to him…he also loves babies and never tires of showing me newborns.  

1/04/07: We collect Eamonn from his two-day trek up Karisimbi Volcano.  His boots and pants are encased in mud and yet his British mug radiates a clean happy energy.  The guide, Felix, reports THAT THIS CRAZY MUZUNGO was at one point sprinting up the 14,000-ft peak whilst waving his porters and twelve-man military escort onwards with all due haste to the peaks of glory.  Eamonn's tale of alpine combat ensues and we learn that his porters each brought exactly one potato to sustain them on the grueling two-day hike.  Felix, the guide, brought only bread and margarine, the later of which he slathered on the former like an over-enthusiastic bricklayer troweling mortar.

On the way home, we pass the health center and spy a swarm of kids playing in the medical waste pit…!  Everything is dumped and burned in that pit: bloody-bandages, used syringes, broken vials, body parts…  We stop and scream at the kids to get the bloody hell out of there!  The infantile mob half-listens to Eli expound upon the dangers of playing in medical waste.  The problem is that the clinic's waste is not thoroughly burned but rather sprinkled with gasoline and ignited - this chars everything but does not destroy all the waste and thus kids jump into the pit to pick through the remains.  When built, the new CCHIPS incinerator will fry all the medical waste to ash and be enclosed behind a security fence - both these attributes shall bring considerable improvement to the local child hygiene and welfare.

 
1/05/07: Eamonn departs for London and is replaced by three MIT student visitors on a three-week study of Bisate water quality.  Joining them is their professor and their professor's daughter, both visiting for just a week.

 
1/06/07: Elie arrives late today because a woman giving birth in a field of beans by his house unexpectedly preoccupied his morning.  The lady was on her way to Ruhengeri Hospital when her water broke miles short of the mark.  She pulled herself into a bean field for privacy and that is where Elie discovered her in time to sacrifice his new shaving razor (cutting the umbilical cord) and his towel (wrapping the baby).  This emergency is preceded by another when Elie's own daughter is taken to hospital sick with serious-sounding symptoms and placed on an IV.

Despite all the newsflashes, it is for us a day of rest.  Quiee-vu-gah – the Rwanda dance in which tribal males heft spears and shake shields while yelling for enemies to beware.

 
1/07/07:  Our friend and local environmental health expert, John-Peter, gives the MIT students a PowerPoint Presentation on what is presently known about the local water situations, sources, and sanitation…  As I am wont to do at PP Presentations, I fall fast asleep.  Elie's daughter returns home from the hospital feeling better.

1/08/07:  All eight of us go to the clinic.  The MIT gang promptly sets off to collect water samples from various Bisate sources: the school, the town pump, the town water tank, Jacqueline's tank, the DFGF Trackers Lodge tank, even two randomly passing jerry cans.  The testing is thorough.  These students are intent on examining each link in the local water chain to see if/and/or/how contaminants enter as it descend s from its high volcanic source to the town well to the town pump and into the children's jerry-cans and onwards down the local gullets.

Four young white females and one older white gentleman freshly transplanted from Boston City, no doubt about it, they cut quite a spectacle in Bisate.  I'm constantly on the run to stay ahead of this roving gang of excited scientists and I confirm immediately that (as hoped) the group does serve as a splendid decoy for distracting attention away from myself.  With the locals finally eyeballing something aside from my own white ass, I'm finally able to capture some shots I've been hoping for… shots impossible to grab when I'm the sole white blip on the local radar screen.  At days end, we return to the clinic, exhausted but contented.

Laura once again finds a sick patient bedded aside a newborn in the maternity ward...a discovery that would be near comical by now in its repetitive nature if the associated danger wasn't so obviously dire.  Laura has been waging an unsuccessful campaign to get the staff to enforce this simple principle: keep diseased patients and newborns SEPARATE!  However, as it has been going, she then returns the following morning to discover another sick patient lying beside another newborn.  The Staff understands and agrees with the principle and yet they seem strangely helpless to enact it.  Changing long-embedded behavior, any behavior, is a tough nut to crack - even when the benefits are crystal clear.  We all must cling to the way we do things…but Jesus Christ stop putting babies and sick people in the same room already!!!!

1/09/07: Day of rest. The MIT group goes off to see The Mountain Gorillas while Laura drives to Kigali to collect a high-school student/volunteer from the airport.  Flora is visiting for three months to work on a soap and a food project for the health center…(a high-school student, just what we need).  Meanwhile, I sit here in my room with my brand new 17' PowerBook DualCore G4 all day and attempt to get caught-up digitizing and logging a distressing backlog of videotapes.

Laura returns with Flora who I notice is much too good-looking to be a high school student.  She is also impressively unfazed by an airline that has just lost all of her luggage.  The girl arrives at our house with nothing.

MonsterDog disinters the buried carcass of a chicken it murdered some weeks ago and endeavors to re-devour it.  The ensuing stench of decay engulfs our house and Laura gags and then shuts her windows, praying that someone else will handle whatever this new nightmare may be.  

1/11/07: If this project is a success it will be because of days like today.  Original plan was to head to Bisate Clinic at 11am but we don't leave town 'til after 2pm due to a stop at Ruhengeri Pharmacy where we cram our LandCruiser full with 2-3 months worth of drugs and medical supplies for the clinic.  In order to fit everything, we pack and then re-pack the Cruiser with an ungodly number of boxes, it takes forever.  This is the enactment of CCHIPS' plan to solve the chronic drug shortages and outages that have plagued the health center for years.  Today, CCHIPS spends $3,000 on drugs, and the center finally jumps a few months ahead of its demand.

Somehow we manage to tessellate ourselves into the vehicle as well and then weigh-anchor for the clinic only to immediately encounter a Chinese road crew and a closed road.  As usual, no sign has been posted to warn of the closure and no information is forthcoming regarding its duration.  Laura's eyes bulge and she goes into her standard tirade of irate screaming, fuming, and fist shaking, after which we wait an hour for the road-machines to clear.

The mood at the clinic is buoyant when we arrive.  More buoyant then I've seen before.  Sunset is an hour away and the day is warm and breezy.  A fair-sized crowd gathers to watch the pharmacy's shelves disappear beneath an onslaught of supplies.  I set-up a time-lapse shot of the Cruiser being unloaded and then lend a hand.  It feels good to carry the supplies inside.  Locals join the effort and the Cruiser is quickly emptied with smiles all around.  The mood is heightened upon learning that several patients on the verge of leaving the clinic due to drug outages can now stay. Outages at Bisate Health Center are over for now.

We've brought new pillows for the patient beds and so the locals are also treated to another 'Bisate First': beds with clean new mattresses, clean new sheets, clean new bedcovers, clean new blankets, and clean new pillowcases on clean new pillows.  It's hard to imagine a more simplistic and inexpensive upgrade and yet the improvement to overall mood is noticeable.  Our only disappointment today is that project founder, Ro Wyman, is not here to share this experience with us - a day that is a rejection of every apathetic soul who bemoans the futile inability of individuals to make a difference.  To those who hold such notions, to those whose humanitarian concerns begin and end in a hapless shrug and a 'what can you do?', to you I answer that the shocking thing is not that an individual can do so little but rather that so many individuals do nothing whatsoever. Mother Teresa once described our limitations as individuals by saying "we can only do small things but with great love."

I keep seeing a little boy with an unsettling face.  Kid can't be more than five years old and yet has such a sad world-weariness to him that it would be comical if it weren't so permanent.  It's an expression I've never seen on such a young face. No one can entice a smile from Mr. Serious.

A newborn greets us in Maternity, a good day.  Then Laura discovers a sick patient in the same room and hits-the-roof so hard that Bisate Clinic is momentarily in danger of instantaneous skylight renovations.  I'll write no further on the subject. 

We almost hit a man on the way home and indeed the man does a little dance over our hood but the Cruiser's breaks save him from a visit to the emergency and, quite likely, the cemetery as well.  Locals trodding this road seem to be stone-deaf and entirely incapable of detecting anything so inconspicuous as a oncoming-high-speed-honking-vehicle.  One of these days we're going to clobber someone but good.
 

1/12/07: Back to the Clinic today. Our high-schooler is impressive, I must admit. A Nutritional Garden is first on the list and Ms. Flora starts right in tilling the clinic's front field while a large local audience gapes in amazement at this young hoe-wielding Muzungo.

The sick ward: a young woman lies in bed covered-over from head to toe by a sheet while crying, moaning, gasping, wheezing.  It is an awful mixture of hyperventilating and shrieking – both common symptoms we're told of mental trauma. Cannot bring myself to film this.  It would be gripping, chilling, heart-wrenching footage but I've never seen anyone in such a state!  Chastise myself afterwards for being cowardly and unprofessional.  Hadn't the heart to capture this one.

A crazy old pygmy lady with a face dired like a prune starts harassing us in the Clinic courtyard and is repeatedly run off by the nurses only to reappear seconds later.  A crowd forms to enjoy the spectacle and the lady has them roaring at her sign-lingual attempts to communicate with us Muzungos.  She's made for the big-stage and uses an exaggerated array of comedic gesticulations to indicate a desire for food, money, and (from the way she's acting) more banana beer.  Bit awkward.  Drives home our ever-present dillema of no handouts…our policy is to avoid handouts like this because it will only encourage everyone else to constantly pester us for the same.

1/13/07: The MIT girls and I trudge into town to visit Ruhengeri Market.  The girls appear to assume that I know where we're going and so I say nothing to correct this misassumption.  I've been living here for several months and I probably should know where the market is by now…perhaps I even do.  Confident in my masculine sense-of-direction, I lead us to the wrong part of town where we wonder about aimlessly in circles for half-an-hour whilst I steadfastly refuse to ask directions and instead continuously reassure the girls that the bloody market is somewhere just up ahead…my house of cards soon collapses and I admit that I haven't the foggiest clue...I AM however 100% positive that the marketplace has not been placed where it certainly should have been placed.

After the girls request directions we locate the market and find ourselves immersed in a claustrophobic affair of sprawling wooden stalls that stretch a square city block.  The butcher's stall is manned by machete-wielding hacker who lifts a swarm of flies off the meat haunch with each blow.  No meat for me today thanks.

The clothing stalls are stuffed with shirts advertising every failed American TV show from the last thirty years.  The shoe stalls dangle their wares from every wooden inch of surface while beyond, over the marketplace wall, rises an enormous green hill topped with a puffy-clouded blue sky.

1/14/07: We shoot more of Jean-Beaufort's music video today.  The 'classroom scene', replete with twenty small children with distressingly miniscule bladders follows the 'kid waking up scene'.  Quite tired today - under confidant that we capture anything of quality.

Major storm hits as we're returning home in the late afternoon.  Electricity goes off and on and off.  I turn in early.

Dog again digs up dead chicken that we buried weeks ago…made aware of this when the smell nearly drops us in our tracks.  Gabby buries the ever-increasingly gnawed carcass deeper.

1/15/07: We retrieve Flora's lost luggage and proceed to the Clinic where Laura discovers that the nurse in charge of hospitalization is stinking drunk.  Laura asks the clinic titular if it's safe to have a stinking-drunk nurse caring for patients.  The Head replies that this stinking-drunk nurse is not nearly as stinking-drunk as he usually is, and so not to worry...how resoundingly comforting. <br>Laura discovers the quality of the local volunteer effort suffers when she is not present to supervise it…two small rooms were supposed to be cleaned this morning look untouched, cobwebs and all (reportedly, they were cleaned this morning by seven volunteers).

Laura and Jacqueline spend an hour discussing the clinic's accounting.  The books and book-keeping methods are in an absolute shambles.  I do not envy the task of sorting it all out.  However, Laura is converting everything to QuickBooks and I trust her to have things shipshape in a month or two. 

Today's success story is that no newborns are found in the same room as sick patients.  After so many consecutive days of Laura exploding over this issue, this news is a relief.  The only problem Laura encounters today (aside from a stinking-drunk nurse and a non-cleaning cleaning crew) is that the pillows on the patient beds have no pillowcases on them…so this does at least permit her a rendition of "this is very bad!" which is her daily-due at this point.

Greg from Amahoro tours takes us on a tour of his Ruhengeri Guest House where future CCHIPS personnel may stay.  Nice place, impressive man.  Wife passed away last year and Greg now has three small children on his hands.  Fortunately, he's also got an unusually powerful entrepreneurial spirit and around here that puts him well ahead of the pack.  He is, I think, doing quite well for himself.

We visit the hilltop Pygmies and order two of their baked-clay plant pots.  I get a big hug from a little pygmy grandmother and stare on in surprise as a small child waddles past us in true Rwandan fashion with a baby strapped to its back…however the child is no more than an inch taller than the baby she's carrying!  I'm impressed.  I then videotape a boy with Dumbo-sized ears.  The surrounding pygmies start cackling because the correctly surmise that I'm filming this kid because he's got freeky-looking Dumbo ears.  Quite true.

Gabby makes a world-class dinner of rice, veggies, guacamole, and beans.  Although sick with Malaria as well as something else the Doctors cannot identify, our guest Nando (a deranged round-the-world Spanish cyclist) is still a pleasure to have at the dinner table.  Anyone who bikes across Africa while being deathly-ill and yet can still manage to make fun of themselves and everyone else too is Aces in my book.  Crazy of course, but still Aces.  

1/16/07: Drive to the clinic today with Flora and Nando.  Stop on the way to visit a Musahe (old man), Kacquera, who crafts the beautiful walking sticks that we see all the local Musahes carrying.  The old guys also wear wide-brimmed Seahorse cowboy hats that, depending on whether the left or right or both brims are turned upwards, advertise how many cows that man owns. 

We're detecting a tendency in this country for people NOT to plan ahead.  When a supply of something, say, for example, vital life saving drugs…runs out, someone thereafter exclaims "Oh my God, is finished!!"  Whatever is finished then remains finished until it can be re-ordered and re-collected a good many days or months later and tough-toenails to anyone who suffers and dies in the meanwhile.  Anyways, thinking of the future is not a Rwandan attribute.  They seem to live only in the now, in this day. 

Today the "Oh my God it's finished!" something is paint.  The painters have had weeks to prepare for the final phase of the painting.  In a meeting with Laura they assured her that all necessary supplies were on hand.  Today, however, they come to do the actual painting and…"Oh my God paint finished!!"  After this discovery they look at Laura blankly, waiting, I suppose, for her to clap her hands and conjure paint from thin air or else dash out and drive the five hours to Kigali to fetch some more.  Laura (as she is wont to do) HITS THE FUCKING ROOF!!!"  She answers with such an earful of angry distain that the project supervisor crumbles like a human piñata of cascading excuses.  The man cannot meet Laura's eyes but rather stands there with a hung and shaking head, murmuring that 'the Holidays were crazy…. crazy!' 

In other news: days ago, Laura bought a large bolt of beautiful cloth to have turned into window curtains for the clinic.  She gave the bolt to the local Bisate seamstress and ordered the curtains cut into 4.5-meter-long sections.  Today the man delivers curtains cut into 1.5-meters-long sections and, rather than making a single curtain to be approved by Laura as requested, he has instead cut all of the curtains to this same dimension.  Laura is incredulous. 

More political intrigue when we return home…but I cannot now remember what this was.  

1/21/07: I stay up much too late working on the project video trailer.  Go to bed at 4am and ruin myself for the following day.  Cutting a 2-minute 'teaser trailer' is not easy.  Two of the patients in it, an old man and a young girl, are now dead.  Ethical and moral questions bubble.  I'm not being paid to do this.  I'm doing it because I want to do something worthwhile…but am I exploiting sick people for my own gain?  There's no way around this question.  My intentions are good though, I think, and I'm trying to be polite about it.  

1/22/07: I'm exhausted all day long.  Should have stayed home and slept.  Instead, I follow Laura up to the clinic to shoot for an hour until I can shoot no more.  I drag myself into the back of the LandCruiser and fall asleep.  Half conscious, I hear there has been an auto accident and the injured are being brought in…but I am so goddamn tired that I'm only able to nod my head and pass out again.  Our good friend and budding environmental health scientist, Jean-Peter, has located a potential A1 nurse for Bisate Health Center!  Obtaining an A1 nurse would be a HUGE feather in Bisate's cap.  A1 nurses have actual nursing-school degrees.  A2 nurses have high-school degrees only while A3 nurses don't even have that.  Bisate Clinic is staffed exclusively with A2 & A3 nurses.  Rwanda has an extraordinarily short supply of A1's - something in the vicinity of only 2,000 for a country of 9 million.  Each year's small crop of new A1 graudates are gobbled up immediately by the countries' few large hospitals.  In these parts, no clinic have any A1 nurses.  Today, however, humble Bisate Clinic is being visited by an A1 nurse named Alphonsine, who is apparently interested in working here!   An offer will be made to sign her to a one-year work contract but I'm skeptical: why would an A1 consider working in the boondocks of Bisate when much higher-paying (and, I'm sure, more satisfying) work can easily be procured at a big city hospital?  It's unfortunate but I'd say that the first grounds for immediately disqualifying any potential A1 candidates from consideration is if the show a genuine interest in working here!  Something must be very wrong with them.

The MIT girls are a pleasant bunch.  We joke around and kill time by munching these annoying 100-calorie snack packs and tubes of Pringles.  

1/23/07: I wake early to finish the video trailer.  Must finish as we're going to the capital today and I'll be handing it to a woman who's flying to the States tonight and she will in return hand it to my partner in NYC.

Tense day in Kigali: Sis, Eli, and Flora all go off on various errands.  I sit in the DFIF office working furiously at creating two CDs of project materials for my NYC partner, Peter.  Cataloging hundreds of pictures takes all day and I end up burning the CDs at the last second while driving to drop them off. 

Before returning to Ruhengeri we stop for dinner at Kigali's sole Italian Restaurant (Papyrus) where we enjoy our first Western food in months.  

 
1/24/07: A warm sunny day with a slight breeze.  A package arrives from our Mother filled with godly things like block extra sharp cheddar cheese and boxes of Wheat Thins and gourmet pepperoni…oganic pudding, yogurt cultures…my! my! my!  Thankfully the MIT students are away in Kigali today and will never need to know about this special delivery, the items of which are quietly spirited off to sundry hiding places. 

Two of Nando's (the mad Spanish Cyclist) friends come for dinner.  One is a Japanese man who has biked here…from China!!!  The other is a German who has biked here from…Germany!!!   Who are these crazy bastards?  The Japanese man, we are interested to hear, has developed the ability to smell what a country will be like as he is crossing its boarder.  Rwanda he says smells of people and green.  

1/25/07: A staff meeting at the clinic to discuss Internal Policies.  The discussion revolves around an awkwardly tacit staff desire to have non.

Visiting university student comes for dinner.  He's studying traditional medicine vs. modern medicine and informs us that there is rampant paranoia within Rwandan society of neighbors poisoning each other!  Apparently much sickness and misfortune is blamed upon poisoning at the hands of one's neighbor.  Seems this poisoning can be transmitted either through actual concoctions or through a sort of voodoo spell.  

1/26/06: Inspection today of the clinic continues for hours by the District Administrator, Emmanual.  Laura can barely contain her inner-rage as Emannual and his committee make what, in her view, are shoddy observations from shoddy supervisors who offer no solutions whatsoever (not even shoddy ones) and who care primarily about cosmetic improvements.  Their questions go something like:  "Do you have a computer?"  Yes…but we can't use it, no electricity.  "Oh well, as long as you have one, that's the important thing." 

It rains…what else is new. 

1/27/06: During my first days at the clinic I witnessed a remarkable transformation that came from just a few hours of volunteers scrubbing dirt and grime off the ward walls.  It was an easy task requiring a bit of bleach and a few cheap scrubbers and yet it was something that hadn't been done in years, if ever.  This task was completed due solely to the outside influences of CCHIPS.  I had wondered during those early days why the locals hadn't done this sort of easy, cheap, and basic cleaning all along?  Did the community not care?  Do they NOT want/need/expect a clean medical center?  I found no answers then.  My answer now is that there is a noticeable lack of initiative among the local population when it comes to doing 'community work'.  One might argue that the nation-wide 'Umuganda' (community-works program) is proof that community work is ingrained in the culture but I would disagree.  Umuganda is a day that occurs once a month during which all citizens are required to do community work.  The population performs this work because it's told to do it, not because it wishes to do it.  When Laura asks the Health Workers to organize a community service day to dig drainage ditches and fill the clinic driveway with rocks the reply is 'we cannot do anything 'til the end of the month because we must wait for Umuganda.'  There's no sense that community work can be done on any other day of the month, there's no sense that people can organize themselves for such things.  'Western' notionns of self-initiative & forward thinking & thinking 'outside the box' are qualities one rarely encounters here.

Beasts of burden are unknown.  Bisate locals work incredibly hard hauling water and farming crops by hand – crops are harvested by hoe-wielders and transported atop individual heads.  Many walk long distances to collect polluted water and when sickness strikes these people go to a filthy health clinic where the general nursing attitude seems to be get better or die.  Such hardships are the norm.  No one complains; there is no one to complain to.  The clinic has been horribly mismanaged for years and yet no one has ever questioned or protested the gross variety of criminal behavior & negligence that have characterized the place.  Drug supplies run out with regularity, diabetes and blood pressure medications are unknown, newborns and mothers are bedded aside the diseased.  Years of clinic accountings are bogus, the health stats are absurd fabrications, money has been stolen, land misused, employees cheated…and never has an opposing voice been raised.  Rather than complaining about the clinic it seems the people just do their best to avoid it altogether.  Most still go to the traditional healers.

With regards to changing and improving things, the local attitude seems cemented around a self-immobilizing notion that improvement and changes are possible only through outside help – namely NGOs and National Government.  No matter that this area receives the least amount of NGO support in the country and that NGO support overall has been steadily declining throughout Rwanda each year and that one hears suspiciously little about NGO projects that have actually made a sustainable difference.

Could the post-genocidal rush of every global NGO to Rwanda leave behind a country so utterly dependent upon outsiders for everything that self-initiative ceases to exist?  What happens when critical problems remain unaddressed?  When community leaders sit idle?  When a clinic is left to rot?  All because of an attitude that eschews self-initiate and self-reliance in favor of a mentality dictating that "only rich outsiders can fix the problems."  There are too few rural Rwandans with entrepreneurial spirit, too few with a lets-it-ourselves attitude.  Perhaps there is too little trust in rural Rwandan communities…how can everyone work together for the betterment of everyone when there is so little trust among everyone?  Is it impossible?  And yet Rwanda's rapid improvements since the genocide have made it the poster-child African countries.  The government does seem to be somewhat competent, honest, and motivated…but these qualities have not yet trickled down to the individual communities in the north. 
 

1/28/07: Quiet day:  Edited Rosamond Carr's memorial.  You can see it on YouTube.com<br>A cheese day: we munch cheese and delectable pepperoni with friends Katie and Glen while lounging on our front porch.  Few things better than a good cheese day. 

MIT Students depart.  

1/29/07: We meet the health center staff in town this morning to truck everyone to the photo shop and then to Caisse Sociale where each will sign them up for his or her Social Security.  Ironically, the old head of the health center, Ali (who was pocketing the staff's Caisse Sociale for years and never openend accounts for anyone) walks past exactly as we're picking everyone up at the bus station.  Everyone says hi and no one mentions where we're headed.

After a day at the clinic, we head home and pass a group huddled around a woman on the ground.  We stop to pickup this woman.  She has been hit by a bicycle and blood is rapidly saturating her dress.  The guy who hit her climbs aboard as well (if you injure someone you pay their hospital bills).  We drive them to the hospital while the injured lady rips angrily into the silent, contrite-looking young biker for the duration of the trip.

PROJECT BISATE:  Lying a spears throw from the Ugandan and Congo boarders amid the towering volcanoes of Central Africa sits the tiny Rwandan town of Bisate.  My sister, Laura, arrives here in September of 2006 to field direct a project aimed at upgrading the town’s one clinic, the worst performing health clinic in this part of the country, a clinic that serves 20,000 people and yet has no electricity, no water, no sanitation, no sterilization, no waste disposal system, no bed-sheets, blankets, or pillows, frequent drug outages, no doctors, no nurses with higher than high-school educations (none with nursing-school degrees), no food, and all windows blacked-out with black paint due to lack of curtains.  Laura finds a dank, dark, foul-smelling place, in which young, old, and newborn suffer, recover, live, and died from or despite an utter lack of basic medical necessities and skills.  The locals avoid the clinic, preferring instead to rely upon the potions and antidotes of Traditional Healers.  A local man, Elie, is hired to be Laura’s Project Manager and Translator.  Elie’s sister came to the clinic one year ago to deliver a baby and no medical personnel were present to assist her, she bled to death, unattended, and her baby died too.  The clinic has been criminally mismanaged for years, the workers social security funds have been stolen; it is a clinic devoid frequently of any staff whatsoever.  Meanwhile, no one in the local community complains. There is no one to complain to.  There’s no concept that there’s anything to complain about.  This is what healthcare in rural Rwanda is like, period.  A month after Laura arrives, I follow her here to document this Project Bisate:
 
2/1/07:
CCHIPS Project founders Bill & Ro Wyman have potential donors coming to tour the health center today.  We all meet at The Gorilla’s Nest Hotel and lunch upon an open veranda with a view of a towering Eucalyptus forest.  I videotape this lunch/meeting and finally capture some primary project characters articulating the CCHIPS Mission.  I spend the whole meal filming and miss all the good eats - hate it when that happens.

CCHIPS Volunteer Dr. Mary has a spark-plug personality.  She volunteered last year at Bisate Health Center and obviously left behind a remarkable impression because for weeks now Nurse Emmanuel and the others have been repeatedly asking me about whether or not she’s truly returning.  I keep answering yes she’s returning, she’ll be here on the 1st…but there’s a fascinating psychological inability among these Rwandans to retain or conceptualize ‘future events’ and so, despite my repeated assurances, their inquiries continued unabated until today when Dr. Mary steps from the Land Cruiser…and then, of course, everybody is completely shocked by her presence because they had NO IDEA she was coming!  The doctor’s arrival sets off extended mayhem at the clinic as she races about shrieking and hugging staff members while exclaiming at the center’s remarkable improvement in appearance.  The rest of us try to remain our composed and professional selves but this is difficult with Mary’s continuous screaming piercing our eardrums. The doctor halts inside the Delivery Room where the usual stench of decaying placentas and blood have at least momentarily been replaced by the smell of a freshly washed and painted room; she takes a deep inhalation and screams for joy.  We like Dr, Mary.

The mood sobers when Mary encounters a badly burned baby in the patient ward.  Its mother pulls back the covers to reveal a thick ugly bubbling-red 3rd-degree burn engulfing most of its chest and stomach, and parts of its legs; utterly unfathomable how the child isn’t chewing its face off.  Dr. Mary explains the trick now is to keep the child warm (it’s another freezing day at the clinic) while allowing nothing to rub against the burn; in short order, Dr. Mary has built a makeshift tent around the small body using a chair and some blankets.  Upon leaning that the burn was incurred by the child’s overturning of an unattended pot of boiling sorghum (porridge), Dr. Mary’s attention turns to the mother and she reassures the woman that this is not her fault, little kids are sometimes too fast and too curious.  It is a touchingly thoughtful action and one that would not have occurred to me - but of course the mother must be feeling terribly guilty!!  It’s a beautiful moment where a few simple words bring a surge of moisture to the mother’s eyes and for a split-second we witness a rare crack in that locked-tight and buried-deep vault that is the Rwandan emotional state.

Bill Wyman impresses today: a genuinely compassionate and intelligent human being, with such an intense, magnetic, and friendly personality that one gets the impression of speaking with a favorite uncle.  Character shines from his eyes and conviction rings in his words and I can think of nobody better suited to present CCHIPS to the world.  

Dr. Mary gushes nonstop excitement while bear hugging a nine-year old child with a chronic scabies affliction.  She successfully treated this youngster during her previous visit and Maronaisa has now become her ‘poster-child’ patient.  Last year, he had arrived with huge, open, freely bleeding ulcers on the backs of his legs that he would scratch with lava rocks they itched so badly…  Three weeks of painstaking care from Dr. Mary had seen these ulcers healed and her reward had been to slowly witness a boy’s face transform from endless unmitigated wretchedness to smiling unmistakable pleasure.  She confessed to my sister afterwards that it was the most satisfying things she had ever done.  Today we see that Maronaisa’s ulcers remain healed but we also see that the scabies colonies beneath his skin appear to be still very much at home.  Mary suspects skin-problems will be a life-long battle for this child.  The boy’s parents were killed in the Genocide but his grandmother is present and we learn from her that Maronaisa detests and refuses to take baths!  One cannot really blame him: taking freezing cold baths in the already freezing town of Bisate would be low on my priorities too.  But scabby afflictions and bathing disinclinations go together like gunpowder and sparks - so we privately decide that we’ll just grab him tomorrow and toss him into a tub by force.  Mary mentions something about patient-doctor trust but I tell her not to worry.

We discuss films on the way home.  Dr. Mary is a Bogart and Hepburn fan and in return I’m fast becoming Dr. Mary fan.


2/2/07:
A busy day at the clinic: Dr. Mary begins by re-dressing Baby Pacifique’s burns. Without a doubt, the procedure is horribly painful and yet the child never bats an eyelash, it just lies on the bed expressionless with one of Dr. Mary’s lollipops stuck between its lips.

Afterwards, Dr. Mary sees an old woman bedridden at the clinic for weeks now due to a badly injured foot suffered in a traffic accident.  The lady is the mother of local carpenter, Francois, a friend.  Her dirty bandages are peeled off and we see that the entire top of her foot is gone, sheered away, replaced by a deep crevice of seeping yellows and grays that appears to somehow bottom-out beneath where the bones and tendons of her foot should be...  Dr. Mary stiffens when she sees the wound; it has plainly been cared for or rather not cared for with a high degree of incompetence.  My first thought is that Ester (the old woman) will lose her foot and maybe the leg too.  Mary compares Ester’s legs and finds that the one with the bad foot is swollen to twice the size of its twin, all the way up to the thigh.  The nurses explain they stitched the wound shut when Ester was first carried in but the wound had broken down.  Thereafter, they had attempted to re-stitch it and the wound had broken down again.  So we are now eyeballing the aftermath of all this breaking-down: a nasty festering mess of flesh that appears to be spreading infection rapidly up Ester’s leg.  Clearly skeptical of the nurse’s treatment method, Dr. Mary takes over and begins cleaning and de-breeding the wound herself.


2/6/07:
Dr. Mary and I are reclining on the front porch with noses in books, enjoying our morning, when a stranger walks though the front gate without knocking; a rude feat in itself but especially so in Rwanda where security is paramount.  I rise to see what the fellow wants, thinking he’s come to collect the stereo we borrowed for last night’s house-party, but instead the man stares at me like a hypnotized barracuda and inquires if I received his messages?  I’ve no idea what the guy’s talking about.  He asks for a job.  I tell him there’s no job here.  He asks me to pay for his education.  I reply no.  There’s a glint in his eye and he ain’t leaving and so to avoid a scene I advise him to return tomorrow if he wishes to inquire about a job and he can speak with the boss (my sis).  This prompts him to exit and thereafter we connect some speculative dots:  a week ago someone dropped an anonymous love letter over our front gate that went something like:

“May God Wills. May You have better morning. Dearest sun shine Rachel Ball?
How are you today?  How will you tomorrow?  Me like a desert girl, you
Still the one to save my life.  As a 4 years old Can you Marry me?  Oh, God How
can I reach on Him again?  Tears inside my Eyes.  Please try to show me Your
smiling because I love You my little angel for ever How can I forget your lap top
Inside my mind?  May you Remind me dear. You Big mountain of Hope, you are
The only one to love. Idol: On ne vue pas Sens dire a Dieu. “

Galileo Crying lonely For you. I promise.

Now, send someone a note like this in the States and your response will likely arrive via federal authorities, but here in Rwanda we give people more leeway on account of cultural and linguistic differences.  This note, however, is followed days later by another one containing hand-drawn portraits of a Western couple sporting the name-tags ‘Rachel Ball’ and ‘Cris Race’.  The drawings are surrounded by such phrases as: “Dear lovely friend, your presence gives us much joy in our family within you: God has hidden great treasure of great mens, so creative and innovative. Live to explore every hidden treasure in you”.  In short, we suspect that this rude barracuda bloke who just traipsed through our front gate without knocking is our secret Casanova…(be he admittedly one of the identity-mistaking psychotic variety).  And, to be fair, the caricature of Rachel Ball does bare a strong resemblance to Laura.  


2/7/07:
Early in the morning Barracuda Man again walks through our front gate without knocking again and strolls onto the porch where he is met at the front door by our house-manager/cook, Gabby, who promptly tells him to get off the porch and go wait by the front gate.  The man replies that, no, he will not wait, he is here to see Muzungos (white people).  Gabby refuses to let him in.  The man takes Gabby’s hand and bends his fingers backwards.  Gabby wrenches free, race to his bedroom, and returns a split-second later with a tire-iron.  This development inspires the man to beat a retreat out of our house, off the porch, and back across our yard whereupon Gabby hurls his tire-iron at the guy’s head.  Barracuda Man smartly ducks the iron, which whirls overhead and into the grass, and then he runs over and retrieves it himself and bolts with it back out our front gate.  By this time, Bill Wyman has caught wind of the situation and Bill charges through the gate in pursuit of Barracuda who whirls around when he hears Bill coming and there is suddenly a showdown outside our compound walls wherein Bill Wyman is advancing upon a stranger who is hefting a tire iron in one paw.  Laura has caught on by now too, and she appears in the gateway and begins screaming bloody murder at the guy.  Meanwhile, throughout all of this, I have somehow managed to remain steadfastly asleep in my bedroom (glad to be of service).  Just before Bill reaches him, Barracuda lays the tool across both palms and offers it to Bill, who takes it.  Confrontation concluded.

Days later, we encounter the young man’s father who is out walking the streets looking for the young man.  He tells us the boy has been upsetting plenty of people lately and he is now searching for his son so that he may literally throw the kid in jail.  We wish him Godspeed.


2/16/07:
Dr. Mary sees a patient: a woman with an abscess on her breast that's become infected.  She prescribed antibiotics for the lady yesterday and had instructed her on the importance of adhering to the dosage.  Today, Mary learns that the woman never received her drugs and upon asking why is informed by the nurses that the lady’s Mutuelle (insurance) doesn’t start for a few more days and so she must either pay out-of-pocket for her drugs (something she’s too poor for) or else wait for her Mutuelle to kick in.  In the meantime, the breast abscess is worsening.  Mary loses it…blows a gasket…and then the whole stack too…I race into the exam room to record for posterity a doctor’s foot-stomping tirade against injustice that finally ends with the surrounding nurses fervently assuring her that the patient will get her drugs, right now, this second, even if they have to force the pills down her throat.    

Discussion erupts at tonight’s dinner table over this situation.  To Mary, it’s intolerably inhuman to let a patient go without treatment.   Laura replies that things are no different in the US, if you’re uninsured and you get hurt or sick, you’re fucked.  Mary replies that in her practice the doctors always manage to find some sort of work-around/alternative solution for those type of cases.  Here in Rwanda, however, such concepts as ‘alternative solution/work-around’ rarely exist, especially at the local health center level.  A roadblock is met and so the nurses stop ‘til it moves.  This is a tough topic to discuss because underlying everything is the fact that a full year’s insurance coverage is $2 per person and so when a disease goes untreated for lack of this sum and when uninsured individuals cannot even afford the ambulance ride to the city hospital, when these issues arise (which they do by the second) they understandably evoke a high degree of shock and moral outrage from us Westerners who spend more on our café latté each morning

There is a lack of quality care and attention for patients with serious problems.  The nurses are trained only to follow specific, set protocols and when a patient’s case falls outside these guidelines, when an unfamiliar stumbling block appears, the effort often stops there…unless of course the patient has a hoping-mad Muzungo doctor as an advocate.  If you’ve no Mutuelle, you pay-out-of-pocket or else return when you have Mutuelle; the severity of your case is immaterial.  Complaints of pain and suffering hold scant weight here and little to no respect or sympathy are shown towards patients.  In Rwanda, everyone has already experienced so much pain and suffering that such feelings are no longer worth much, no one pays attention; no one cares about you or your problems.

Dr. Mary tends to a lady who lies groaning in a clinic bed.  The woman is the president of a local club and last night she returned from a club meeting at 6pm - a bit late in the eyes of her spouse who vented his frustration by kicking the shit out of her.  Local law prescribes that if you put someone in the hospital you must pay their hospital bills and ensure they eat while recovering (there being no food program at the clinics).  After the beating, the pugilistic husband goes AWOL but in order to fulfill this social obligation the man sends his mistress to the health center to care for his wife…(the appropriate expression is, I believe, ‘adding insult to injury’).  Today the mistress sits across from her lover’s bedridden wife and ‘sees to her needs’ while both engage in what I interrupt as a silent war of bottled hatred flavored with shards of loathing…AWKWARD!

Cute scene today: Laura has for some time now been planning to remedy the health center’s courtyard.  When it rains the yard becomes a sizeable lake and her idea is to negate this aquatic transformation by filling the courtyard with 5cm of rock and 10 cm of soil.  Today is about the 5cm of rock.  To this end, Laura has elicited the child-labor assistance of our neighbors at the Bisate School.  At 3pm, three to four hundred students ranging from two to six feet in height converge upon the clinic carrying all manner of volcanic stone to toss in the courtyard.  For the next hour they continuously parade in and out of the driveway in a swirling cyclone of blue and tan school uniforms, halting just long enough to drop a rock on the next kid’s foot and to stare in wonder at the on-looking line of Muzungos frantically taking their photos.

This evening I sit down in my room and discover that I’m angry, furious.  Angry at the world: a naïve, silly sort of thing to be angry at.  Not asking for a perfect world, mind you…but just one that’s, say, barely adequate?   People should never suffer or die for lack of a $2 insurance card.  People in physical misery and abject squalor should never live in plain view and be ignored.  But who am I to say such things?  Who am I to complain or condemn?  I’m just another outsider describing obvious well-known problems while offering nothing in the way of solution.  I’m also from a country with the best doctors and healthcare in the world…provided you’re either filthy rich or employed by the right sort of large corporation, otherwise you’re also fucked.  Rwanda and the US therefore have something in common: both our medical systems are lacking.  That said, I’d advise anyone with the option of choosing between the two to pick America; better to spend a lifetime paying medical bills than not to spend a lifetime.  

Juggernaut insurance corporations and monster drug companies with their governmental lackeys and political protections and subsides prevent the US from enjoying a healthcare system that COULD provided CHEAP, BASIC care to everyone - is this the verbal debris one expects nowadays from a pinko left-wing liberal propagandist north-eastern-college-town-spawned peace-spewing socialist-dove like me?  I agree with Paul Farmer: great healthcare is a human right not a privilege of wealth; unfortunately this is clearly not the case today and from all indications it will never be.

Tonight I return to a hot meal, a warm shower, a clean bed, and to a life that has little in common with the people of Bisate.  Can I relate?  Maybe no.  Living in a freezing, smoke-filled mud hut with a leaky roof, dirt floor, no electricity, unclean water, five kids, no money, and nothing to nosh on but potatoes and corn is something I cannot relate to, nor is it something I wish to relate to…but this is largely a matter of perspective and this is only mine; for the inhabitants of Bisate, however, such hardships are no more than what is expected, accepted and cherished, as plain-old familiar take-it-for-granted every-day normal life.


2/19/07:
I setup two time-lapse cameras to record today’s effort to dismantle the old kitchen structure (to make way for the new water tanks) and once my cameras are clicking away, I rollup my sleeves and partake in the destruction.  Something about ‘tearing shit down’ has always been inherently appealing to me.  My fondest childhood summer was one in which the parents decided to deep-six our old garage and two backyard sheds.  They were presumably discussing the expense of such a project when they realized they owned six little monsters who did nothing else but destroy everything in their path…so they set us loose on the project and we wasted no time unleashing a hell upon those flimsy structures that ran the gambit from rage-induced sledge-hammering contests to drawn-and-quartering sessions involving family vehicles being driven away at high speeds with gas-pedals floored and ropes running from bumpers to structural beams that either tore the beams down or else ripped the bumper right off the back of the family van.  But I digress.

To avoid the time-consuming and awkwardly silence-plagued Rwandan chitchats that inevitably pursue Muzungos in Bisate, I’ve taken to keeping in constant motion while at the clinic; it’s harder for the locals to bog me down if I keep up a head of steam.  Today while circling I discover that the clinic recycles its used prophylactic medical gloves.  I get a great shot of dozens of these gloves spread over a sheet on the ground; they’re washed, sun dried, and reused – impressively environmentally conscientious but similar conservation efforts back home would probably get someone fired.

The abused woman’s husband visits the clinic yesterday to warn his spouse that she’ll receive more of the same when she comes home.  Unless he inflicts seriously life-threatening injuries, there’s apparently little to nothing anyone can or will do about it.  Fortunately, the man’s mistress has remained available to tend to his wife’s hospitalization needs…  Cases such as this are heart-wrenchingly common and there are always several children involved and often the bedridden mother has no idea where they are or who is caring for them.  Rwandan women, it seems, have little power over the domestic-abuse realm; surprising since Rwanda is a country where women occupy every rung of the work-force and social ladders…but perhaps this doesn’t count for much here in the boondocks.

Evening finds us back home after a long, weary day.  I enter the dining room late and sit down to sip some soup, noting only that a normal flow of conversation seems to be occurring between Laura, Dr. Mary, and Ro…when suddenly BANG!!…out of nowhere…Mt. Wyman ERUPTS WITH FURY!  A shockingly abrupt and nasty fight explodes without warning between all three of these ladies who comprise the heart-and-soul of the CCHIPS project.  Ro is screami