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Clinics Rising mission is to create advocacy through storytelling for organizations and people doing amazing work in global health care. ClinicsRising is a project of Human Condition.


Recommended Reading
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Sean's Diary

This is the diary of Clinics Rising senior filmmaker Sean Clauson. It includes his writings, that he started over a one and a half years ago on his way to Rwanda to document WWHPS. For the sake of clarity, these entries are posted in chronological order, like an actual diary.



 A forward by Sean:

Sitting amidst the towering volcanoes of Central Africa a spear’s throw from the Ugandan and Congo boarders lays the tiny mud-hutted village of Bisate, Rwanda. My sister Laura arrived here in 2006 to field direct a project aimed at upgrading this town’s only medical center, the worst performing center in the entire region, a decrepit clinic that serviced 20,000 people and yet had no electricity, no water, no sanitation, no sterilization, no waste disposal, no bed-sheets or blankets, frequent drug outages, no doctors, no nurses with above high school educations (none with nursing school degrees), all windows smeared-over with black paint due to lack of curtains, and no food. Laura discovered a dark, dank, foul-smelling place in which old and young suffered, recovered, lived or died, from or despite a complete lack of basic medical supplies and training. The locals avoided the clinic, preferring instead to rely upon the potions and antidotes of the traditional healers. Laura hired a local man, Elie, to be her project manager and translator. Elie’s sister came here one year ago to deliver her baby at the clinic but no nurses were present to assist, she bled to death unattended and the baby died too. The clinic has been criminally mismanaged for years, a decade of social security funds were stolen from its health workers. The place is frequently devoid of any medical staff whatsoever … but no one complains … there’s no one to complain to … there’s no concept that there’s anything to complain about. This is how healthcare is in rural Rwanda, period. A month after Laura’s arrival, I followed my sister here to document this clinic renewal project. Today, 2 years and a thousand battles later, Laura is still here, still engaged in a silent war that can never be won:


November 2006

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.   


December 2006

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 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 –  Probably taken.  Or perhaps

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.


January 2007

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 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 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<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.


February 2007

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:
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.

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.

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.  

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.

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.

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 screaming that she isn’t being listened to or valued while Laura and Mary respond with stunned disbelief and denial.  Ro storms off and slams her bedroom door shut, leaving us with our soup spoons half raised while listening to her muffled sobs.  Laura has risen in outrage and cries-out chokingly “frankly I don’t know if this job is worth it!!” and runs off shaking to her own room.  Meanwhile, Flora, Gabby, Dr. Mary and I remain seated at the table in a state of shock which I eventually break by saying something along the moronic lines of “that’s alright, these things happen on occasion, don’t you know”.  With three such strong-willed women at the center of this project conflicts like this are perhaps unavoidable…not that I’d wish them to be avoided, mind you, I’m a fan of venting when one needs to vent, and I’m completely in favor of such outbursts when by blind fortune I happen to be sound-recording the entire affair on my micro-track audio recorder, which is what I’ve just done (such unexpectedly dramatic discourse is pay-dirt as far as my exploitative entertainment concerns).  So I finish my soup, turn off my micro-track, and go to bed rather contented.

On the way to the clinic we pass a man shuffling along the road.  His hands and feet are manacled together with heavy clunky rough iron collars that look like something out of slave trade.  Just enough chains separate his ankle manacles to permit the slowest of forward waddles.  Laura explains there are no mental health facilities hereabouts and so people with such problems who’re considered potentially dangerous are allowed to wonder about but are thusly restrained.  I’ve never seen anything like it but I believe something similar was practiced in medieval times.

Today, for the first time, I encounter elephantiasis in the form of an 18-year-old girl with a foot that looks like a spreading tree trunk.  The exam room is dark and I cannot get a good shot for my camera so I find myself just staring at her gnarled, massive, bark-like appendage, it is completely out of proportion with the rest of her and without reference to her upper body it would be impossible to identify it as human; it is the foot of an elephant.  The girl is emotional, which is rare for Rwandans, she cries I think in response to Dr. Mary’s medical questions which touch upon childbearing and partners…I suspect such topics strike upon a personal conviction that the disease has precluded her from ever enjoying such things – things she must view as being so taken completely for granted by everyone else around her.  We discuss getting her some shoes - nothing conventional will fit of course - but we hear that someone in Ruhengeri makes sandal-type-of-things from car tires that have worked for similarly afflicted people.  I’ve heard Elephantiasis is good indication that a person has spent time in a Congolese refugee camp; and sure enough this girl has.

In other news, the man with machete head-wound is getting better.

On our way up to the health center we stop for two bags of gravel and end up filling the bags ourselves when Elie learns that the sellers are planning to charge us Muzungos for this usually free service.  ‘Muzungo surcharges’ are normal and occur everywhere for everything that hasn’t already got a price clearly listed on it.  Prices quoted to those of the white-skin persuasion are typically 30% higher than those quoted to locals. Though, of course, there are many young entrepreneurial salesmen around whom up the price even further, anywhere from 100 to 100,000 percentiles, depending on how white and stupid you look.   

Dr. Mary worries about a sick boy who was transferred yesterday from the clinic to Ruhengeri hospital.  Once a patient is transferred it requires a small miracle to keep track of them, as the entire system is a jumbled chaos of impenetrable confusion.

Laura invites Dr. David over for dinner and Gabby makes Pizza for the first time.  I’m pissed-off all day long for some reason…?  Darn chemical imbalances.

Digging commences for the construction of the water-tank base and also for the shelter structure that will serve as our meeting area and soap-making project facility and temporary patient kitchen.  Ro & Gabby spend all day building a lava-rock wall (which will be entirely torn down in a month’s time to make way for the shelter structure’s foundation).  Dr. Mary leads a Health Animator training session while I waste the day shooting Super8mm time-lapse photography that will bitterly disappoint me when I see it three months from now.  Ro & Laura are still on edge over the dinner-table explosion two nights ago.  Clinic Health Worker Joseph eats pizza for the first time ever.

I awake feeling less than stellar.  Something is coming and it feels like Sickness City.  I inspect my epidermis for mosquito bites but find nothing of alarm.  My Larium pills have remained untouched these past two months because of the side effects (extremely vivid dreams); I was waking-up completely exhausted before my day had even begun.
We wind our way up to the clinic, where Laura, Ro, and John-Peter give a tour to a group of American visitors, one of whom is an ex-CEO of Coke.  The visitors ask smart questions and seem genuinely interested in the project; hopefully they’ll be in touch.  

Five minutes after these visitors departure I’m sitting sardine-ed in the Land Cruiser with nine other Rwandans awaiting our own exodus when a throng of locals descend upon the clinic.  Unpacking my gear, I squeeze out to investigate.  People are everywhere, pushing, pulling, yelling; Sis arrives to report that the mob has brought an eight-year-old girl and her rapist…  I’m hearing this as the mob spills out from the clinic’s exam room and rushes past us to the sick ward, hauling with it a young man in a white coat and a battered face.  This man is sat down upon a bedside and we’re told that the child under the covers is his victim.  Why then, ask Ro and Laura, is he sitting on her bed!!  The girl apparently IDs the man who then remains seated beside her for the next half-hour as a discussion wages over what to do about him (there being no local police department).  Someone, it seems, has already done a bit of something, as the man’s face is a swelling topography of blood and bruises; he has obviously undergone a comprehensive beating.  After much discussion, the mob grabs the guy again and hauls him from the room and away from the center.  We go home.

Wake up sick and gorge myself on Dayquil before heading to the clinic.  The raped eight-year-old is still there: a tiny baldhead with large white eyes.  Her family hasn’t come yet.  The nurses have re-outfitted her in new clothes taken from a dwindling supply of garments donated by Ro Wyman who spends most of her day fawning over the child.  The kid gets out of bed and sits outside for a bit.  She looks fine but never utters a word.  I wonder what stigmas, if any, are attached to victims of rape in this country…no idea.

Two engineers follow us to the clinic:  Chris and his fiancé, Antje.  They’ve just spent several months building a well-received model house in Kigali made from a new and simple pressed-earthen brick technology that has the potential to revolutionize the cost and quality of local housing.  Regular bricks are banned in Rwanda due the wood fires needed to make them (wood is a restricted resource).  Chris and Antje’s program provides that if the right type of local soil is available this technology can be employed to manufacture durable brick houses for a pittance of the usual price.  No one in Bisate has ever been able to afford a brick house - the local design consists of an abode with walls made of flimsy crisscrossed poles packed with mud and a roof of either tin or thatching; the benefits of this new technology are therefore potentially substantial.  Today, Chris is here to collect soil samples for testing back in Kigali, they run tests to determine the particular local mixture of soil, rock, and cement that will make for the best earthen bricks.  CCHIPS plans to use their technology to build the health center’s new kitchen.

Go to bed sick and awake sicker.  Zero energy.  Filled with a feeling of utter malaise.  Electricity has been out for two days so there’s no hot water.  Laura boils me a bucket and then spends the remainder of her morning collecting building supplies in town for the clinic’s new gutters…this permits me time enough to overdose on Dayquil capsules, poor a bucket of hot suds over my head, and piece myself somewhat together before Laura drives back in, collects us, and up we go to the clinic.

I stick my melon into the sick patient ward and eye an unconscious baby on a bed with an IV-drip tube poking from one arm; Nurse Emmanuel tells me it’s a possible case of Malaria.

The eight-year-old rape victim is gone, taken away by the police.  Her family was informed about the crime two days ago but never came for her…  It had been arranged for us to collect the family yesterday in Ruhengeri and drive them to the clinic but they never showed up at the pickup point.  Something strange about the case – the locals tell us the girl came to Bisate to beg…and yet she lives near Ruhengeri…and no one would ever travel all the way up here to the impoverished miniscule mountain town of Bisate in order to beg when they live near Ruhengeri, the largest and wealthiest city in these parts!  Makes zero sense.

Main issue discussed in today’s Health Committee meeting is the possible firing of a frequently absent nurse.  The Committee cannot fire him, however, as the nurse is hired by the Health Ministry and is therefore apparently somewhat untouchable on the local level, Laura disagrees with such notions and is ready to get rid of him herself.  We then learn that the nurse is HIV-positive though and things simmer down a bit after that.

We’re on the verge of departing for the day when the raped child’s family appears.  They have that exhausted haggard look of people who’ve been journeying without food for much too long.  We learn that originally they’d thought the child had been taken to a different health center, after discovering their mistake they’d crisscrossed the countryside trying to figure out where the hell she was and now they’d finally found the right clinic only to learn that she has been taken elsewhere.  Someone informs us that the police took the girl back home, so we load the family in the Land Cruiser and take off for Ruhengeri.  I feel terrible throughout the drive.  Laura had packed food and drink for the victim’s family but, upon hearing this morning that the girl was gone, I’d assumed that the family must be with her, so I ate all their food (yes, sorry, I’m an asshole!).  So, anyways, off we go, taking the family back to its home and child…and by and by we discover that although we thought we knew approximately where this family lived it turns out we had no idea, they keep pointing us further down the road and after several unexpected miles we suddenly find ourselves directed off the main road and begin bumping along a rutted mud path leading across an immense plain filled with nothing but trunk-to-trunk banana trees.  We drive for some time and then stop in the middle of nowhere.  No hut is visible but through the banana leaves off to our left we spy a tiny figure tentatively moving toward us.  I shamelessly lift my camera in anticipation of a tearful reunion…(not being one to rebuff an Oscar award-winning moment when it’s being spoon fed to me)…but the joyous embraces and jubilant shouts never materialize because, you see, we’re in Rwanda...which means that nobody’s facial expression changes, no hugs are given, no tear-spattered greetings exchanged; absolutely nothing whatsoever occurs that would make an onlooker even suspect that something unusual is taking place.  The mother goes up the path and returns with her daughter. The victim never says a word and nor do the parents; it is as if nothing traumatic has transpired.  We’re soon thronged by the usual hoard of curious family and neighbors and so Ro give the girl some small gift items and we say our goodbyes.  On the way home, John-Peter tells us that the rapist got a 25 year jail sentenc.  This news amazes me…they caught the fellow two days ago!  Holy Shit, talk about some churning wheels of justice.

Go to bed sick & awake sicker: no energy, splitting headache, fever.  No willpower for anything besides feeling terribly sorry for myself, my poor, poor little self.  Malaria?  Yellow Fever?  Parasites?  Jaundice?  Cirrhosis of the liver?  All five!  Remain curled in the fetal position all day long sucking my thumb and asking for Mommy.  Picture myself lying like this in a Bisate Health Center bed and try to thank my lucky stars but GOD DAMN IT! Cannot stand being bedridden like this.  Life blows.

Baby on an IV-drip died last night.  Being on an IV in this Joint is dangerous business.  I’d eyed the infant two days ago, debating whether to shoot footage and deciding against it as I’ve already logged an abundance of IV-baby footage.  Now I wish I’d let the camera roll.  Photographing the dying is ethically murky ground but so is passing through life without ever having your picture taken.  

Chap and his wife are using a ladder of crudely nailed-together branches in order to put up the clinic’s new rain gutter supports.  Rather than propping the ladder against a wall or roof-beam, however, they angle the ladder away from the building and prop it up with a long piece of wood with a Y at one end.  The lady braces the crutch while her man does the climbing.  I would describe it as an extremely homemade sort of production.

I want to become more than what I am.

Have begun reading random pages from Paul Theroux’s African travel book, “Dark Star”; some pertinent bits:

“All news out of Africa is bad.  It made me want to go there, though not for the horror, the hot spots, the massacre-and-earthquake stories you read in the newspapers; I wanted the pleasure of being in Africa again.”  (Paul Theroux, Dark Star Safari, pg 1)

“After I left Africa, there was an eruption of news about things going wrong, acts of God, acts of tyrants, tribal warfare and plagues, floods and starvation, bad-tempered political commissars, and little teenage soldiers who were hacking people.  “Long sleeves?” they teased, cutting off hands; “short sleeves” meant lopping the whole arm.  One million people died, mostly Tutsis, in the Rwanda massacres of 1994.  The red African roads remained, but they were now crowded with ragged, bundle-burdened, fleeing refugees. Journalists pursued them.  Goaded by their editors to feed a public hungering for proof of savagery on earth, reporters stood near starving Africans in their last shaking fuddle and intoned on the TV news for people gobbling snacks on their sofas and watching in horror.  “And these people” – tight close-ups of a death rattle – “these are the lucky ones.” (Paul Theroux, Dark Star Safari, pg 2-3)

Some of Theroux passages do make me feel uncomfortable and certainly make me look at our project and others like it with different eyes...  Damn you Theroux, for holding up such a mirror!

Complaint time:  Rwanda toilets.  No good.  In the West we sit down, read something, relax, close our eyes, yawn, stretch, scratch, no big deal…but whatever we do we never spend a single moment worrying about aim.  Aim!  Never.  We cannot miss; it’s a logistical impossibility - if you’re sober, your shit’s going down that crapper no mater what.  Not so in Rwanda.  Squatting: squatting is stressful, not only on the knees but on the mind also, you do really need to know from where it is precisely that you purge, anatomically speaking, cause we Americans have big Asses and there’s a range of possibility there, especially when dealing with the galling minuteness of the vaunted Rwandan toilet hole (touch your thumb and middle-finger tips together and you’ll get the idea).  We Westerners are therefore called upon to battle an enemy from the unfamiliar, unstable and uncomfortable position of the squat.  In essence we become World War II bombers consulting our gyroscopes and gauging wind direction while making those final last-second fine-tuned adjustments before opening the bomb-bay doors and loosening an irretrievable payload with fingers crossed and prayers silent.  Miss and things get messy.  My policy has therefore been one of aggressive avoidance and tactical perimeter restriction; I avoid whenever possible all Rwandan toilets and confine my bowels to the sphere of our project house’s westernized installations.  If and when I get caught behind enemy lines, I shut my eyes, visualize hitting a hole in one, and never look down. That’s the strategy, that’s the mission, that’s the secret: never look down.



March 2006

SEAN BLOG - March 2007: 4th Month in Rwanda

BACKGROUND:  Lying a spear’s throw from the Ugandan and Congo boarders amidst the towering volcanoes of Central Africa sits a tiny Rwandan town called Bisate.  My sister, Laura, arrived here in September 2006 to upgrade the town’s Health Center which serves 20,000 people and has no electricity, no water, no doctors, no sanitation, no sterilization, no waste disposal system, no bed-sheets, blankets, or pillows, frequent drug outages, no food, no nurses with higher than high-school educations (and none with nursing-school degrees), and no window-panes that hadn’t been blacked-out with black paint (due to a curtain shortage).  Laura found a dark, dank, foul-smelling place, in which young and old suffered, recovered, or died from or despite a complete lack of basic medical necessities.  Laura is field directing a small project focused on improving these miserable conditions.  A local man, Elie, has been hired to be Laura’s project manager and translator.  Elie’s sister came to this clinic one year ago to deliver her baby but no medical staff were present to help her, she bled to death and the baby died with her.  The clinic has been criminally mismanaged for several years and is frequently devoid of any staff whatsoever.  However, no one in the Bisate community complains, there is no one to complain to, and there is no idea that there is anything to complain about – this is what healthcare is like here, period.  A month after Laura’s arrival, I follow her to document the project; below is my account:

“No one ever dies.” – quote from Bisate clinician

We drive two hours to the Rwandan capital, Kigali, where we stop at the airport to bid our project president, Ro Wyman, farewell…only to learn seconds later that her flight has been cancelled (Rwanda, thankfully, is NOT one of those arrogant countries where passengers can ‘call ahead’ to check on their flight’s status).  Ro will be spending another night upon African soil.  Meanwhile, I bounce over to Kigali’s fancy-shmancy Novitel Hotel for my first haircut in a year - my friend Glen swears that these Novitel barbers are the only ones in the country who can cut ‘Muzungo hair’ (White Man hair).  I wait my turn beside my friend Gabby (our House Manager & Cook) and watch as he chomps upon a freshly baked giant croissant, most of which is crumbling down his chin and onto the barbershop floor.  Every three minutes a woman with a broom and scoop obligingly appears to scoop away these croissant-crumblings.  I watch this in horror.  After a while, the woman also points to my own as-yet un-munched croissant and beckons for me to begin slobbing away as well, waving at her broom and scoop to indicate that she’s all ready for me.  I shake my head in shock and place my crumbly consumable away for later.  A floor isn’t a plate!

With regards to my haircut…I’d thought I’d seen it all…my poor head-o-hair has been butchered around the globe from Hanover to Hanoi (where a Vietnamese chap once used nothing but a straight razor).  Rwanda ads a novel twist today when the barber, upon encountering my hairy white neck, exchanges his sharp razor for a dull one and the ensuing mow is so painful that it leaves all my remaining hair standing on end (kudos if this was an intentional hair-styling technique)…but this pain is nothing…NOTHING! …compared to the intensely riveting agony uncorked when this barbarous barber bastard douses my freshly-shorn-neck-flesh with a liberal dollop of Hydrogen Peroxide!  I stifle a scream as my face turns as red as a Stop sign and my hands vice-grip the seat sides.  Were I a POW I’d a spilled every last military secret in record time.  Anyways, after this hairy interrogation, I seek solace beside the hotel pool and start nibbling on a mini pizza (comfort food) while Gabby sits across from me gorging himself sick on his first-ever giant chocolate éclair…all of which, I note, is somehow making it into his mouth.

Laura collects us from poolside and we rendezvous at ‘Modern Supermarket’ (actual name), which is such a wonderfully restorative civilized refreshingly westernized-type-of-place…and sheer Heaven after these many months of surviving in a town that hasn’t got any butter!  Next door to ‘Modern Supermarket’ is Rwanda’s first ever ‘Starbucks-type coffee place’: it’s newly opened and we take refuge inside for a blissful hour of sucking down grande-sized-cappa-mocha-chino-latte-bullshit-type drinks while envisioning that we’re in Manhattan with a Barnes & Nobles just downstairs.  Our translator, Eli, imbibes upon his oversized mocha-latte-caramel-whipped-cream-venti-crazyccino drink like a bear with a honey-pot, stirring it occasionally with a dreamy expression, while intoxicantly intoning “you know Sean this is beer, I am making beer here...”  It is the closest we come to a religious experience in Rwanda.

Play a vigorous game of tennis with Glen this morning and I might add that since commencing this bourgeois sport a few weeks ago I have yet to lose a single match!  Apparently being a natural-born athlete is my cross to bear.  Our 18-year old vunder-volunteer, Flora, is sick today and cannot play.  I’m concerned, as one can only imagine the ravages inflicted upon a delicate Western immune system by four months of Ethiopian Orphanage living (from whence Flora has just come) followed by three months of rural Rwandan living (her current pursuit)…but Flora is a tough nut, you’ll see, and I am betting she’ll be just fine and dandy by tomorrow.

Flora continues to feel sick today and so unless something changes quickly I suspect she’s on the verge of becoming the first white person to be treated at Bisate Clinic.  I personally cringe at the thought, as this would no doubt necessitate the collection and delivery of a fresh fecal sample…call me a limpid leprechaun but such degradations are beyond the pale for me – just too fricken mortifying for my delicate sensibilities – better to die.

Cannot recall what I did today…something of import no doubt…if you know what I did on this day today please write me at

Days here blend together and dissipate like smoke rings in the wind and concepts such as Time and The Future are only as meaningful as the rain clouds on the horizon.

Together, Flora and I have diligently ploughed halfway through the first season of ‘Lost’ (on DVD) only to abandon it today when Flora officially declares it monkey manure.  I regrettably agree…the series began all right but has corkscrewed rather quickly into a nonsensical mess where the more you learn the less you understand and the further you go the closer you arrive at concluding that this particular narrative is a treadmill to mindless oblivion.  So we chuck it all in favor of a sure bet: The Lord of the Rings Trilogy!  Now THIS is a SAGA!  Love the books, love the movies…only drawback is that since becoming sick a few days ago Flora now needs to take bathroom-breaks at five minute intervals! I glue the Pause button to one thumb and dust off my waiting skills…God Damn Intestinal Parasites!

Relevant Side Note:  Here in the tiny Muzungo (White Person) Community of Ruhengeri, one’s status is tied directly one’s DVD collection, which, in turn, is inversely related to one’s sanity.  Let me explain.  There are nine Muzungos living here and all of us are in the same predicament - cut off from our societies, friends, and families, in a place where beyond these barbed-wire-topped compound walls there is extremely little in the way of recreation, entertainment, or fun.  We therefore have scant recourse but to immerse ourselves frequently in Hollywood’s Finest in order to achieve a measure of stress relief.  Indeed, our collective sanity is so DVD-dependent that everyone is somewhat perpetually on the prowl for new movies – and one finds oneself too frequently receiving or releasing long diatribes of “seen it, seen it, seen it, seen it, seen it, seen it…” while flipping though someone’s collection.  The most popular Muzungos here are the ones with the largest DVD collections but these larger collections also denote longer stays within country and, thus, are quite accurate indications of the owner’s mental deterioration (since the longer one stays the crazier one becomes).  Therefore the ‘coolest’ most respected Muzungos among us are the craziest as well…so here I sit eyeing my own rapidly growing DVD collection with equal parts trepidation and pride.  In layman’s terms: these disks are the equivalent to radioactive bars of gold.  And, yes, delivers to Ruhengeri J

We make a late afternoon trip up to the clinic stopping on our way to collect a handyman named Joseph who may be in charge of building the new Meeting Area structure.  We stop at the fancy Gorillas Nest Hotel to show Joseph an example of what’s structurally desired…and a good thing too because we discover the man has completely misunderstood Laura’s initial explanations of what’s wanted and has instead drawn-up plans with triple the previously agreed upon number of support beams…the guy’s got beams all over the place…where the hell are the people going to go, we wonder!  My gut tells me this chap ain’t fit for the job – building a mud & stick hut is one thing, building the Greek-temple Laura is describing is quite another...

Entering the clinic yard, we find work on the new water-catchment system in progress; some of the rain gutters are already up and the reinforced cement base for the four 10,000- Liter water storage tanks (which those gutters will be feeding) is nearing completion.

A woman is carried in on a stretcher.  She cannot walk so Nurse Emmanuel partly carries and partly drags her to a bed.

I lie in my bed logging footage for several hours before escaping off for tennis with Flora.  All that’s keeping me sane right now is Yogurt, my kitty-cat, Gomi, and Tennis.  During our match, my serve discovers itself and suddenly I’m hammering balls so speedily past Flora that she is unable to see them as they zoom past her for ace after ace after ace after ace…  My life-long-tennis-winning-streak is kept very much alive.  

On the way home, we’re bouncing along a rutted lane when the Land-Cruiser is suddenly besieged on all sides by a pack of local urchins one of whom has the audacity to jump onto our moving vehicle (these local whippersnappers are wont to do such things)!  I scream, screech to a halt, throw open the door, and tear after an exploding beehive of adolescents while waving my arms about in a tizzy.  The one I’m after sprints away so swiftly he leaves behind one of his sandals which I violently grab-up and shake in the air before springing back into the Cruiser and triumphantly burning rubber out of there with the punk’s footwear clutched firmly in one paw and the flames of madness dancing inside my retinas.  In the rearview, I see the one-sandaled tyke reemerge from a bush and hop pathetically after us.  I open my window as we vanish from sight and send his footwear hurtling into the air out over a big field of potatoes.  “Suck on that you little bastard!” I scream, and then apologize to Flora for being such a psycho.  These little Rwandan runts are driving me slowly insane.  

Laura too is also steadily “losing it”.  She blows her stack at tonight’s meeting with Elie (our translator) and Jacqueline (the head clinic nurse).  Laura has spent the last several months agonizingly computerizing all the clinic’s health data in order to remedy the chronic accounting errors and omissions that have plagued this clinic’s books since forever.  Laura’s knows this new computerized system will free Jacqueline from hours upon hours she currently spends every week checking, re-checking, and transcribing all this health data by hand!  Tonight, however, after the entirety of the data has finally been entered and updated and victory assumed, Laura suddenly finds her-self eyeballing Jacqueline who is transcribing all this entered and tallied and verified computerized data back into handwriting!!!  “What! What are you doing?” asks Laura, “I’ll print you a copy!!”  Jacqueline, however, declines, replying that she must of course transcribe everything back into handwriting since the Ministry of Education Office only accepts hand-written data!…printed data isn’t considered “trustworthy”, you see, while handwritten data is considered “trustworthy”…and so of course we must transcribe everything back into handwriting so the Head Office can see that our data is “truthful” and can then type it into their computer.  To reiterate, to accurately compile our clinic’s medical & financial data and comply with local filing customs, we must take the clinic’s handwritten records, transcribe these into our computer, then re-transcribe this digital data back into handwriting so that it may be re-verified by someone who will then re-re-transcribe it back into another computer…(for me it recalls that line from A Beautiful Mind “petrified, mortified, stupefied”)…it’s like we’re playing the adult version of that infantile game called ‘Telephone’.

Laura totters upon the edge of a mental breakdown.

Yours Truly makes the best dang yogurt he ever tasted and then spends much of the day tasting it.  Had hoped to play tennis with Flora this morning but she’s busy in the backyard rearing baby plants for the clinic’s new nutritional program and Glen, our tennis-playing neighbor, is off to Uganda all week…so no tennis for me today.  

Got great news yesterday that Eamonn’s (my sister’s boyfriend) job in Saudi Arabia appears to be going through.  Laura is tickled.

My birthday package arrives two weeks late.  Inside are 3 boxes of Wheat Thins (the best dang cracker in the whole world).  For some devilish reason one box of Wheat Thins has been marked “For Gabby” (our cook)!  What the hell is my Mom thinking!  I mean whose fucking birthday is it anyways!  But anyhow, two rounds of cheese, three pudding packs, and, joy upon joy, three delectable rolls of gourmet pepperoni…so Mom has done me proud.  Local meat is disagreeable, gristly, chewy, relentless stuff that makes one sick…hence my behavior towards this special imported gourmet viand is somewhat akin to that of a captive cabbage-fed Veloci-raptor set free in a cattle yard.  

We go to the clinic.  I shoot time-lapse footage of the roof going up over a nearly completed water storage enclosure.  My Super 8mm snaps away at 1 frame every 5 seconds while my DVX-100 rolls on the scene in regular mode (24PA) - I’ll speed this up in post.  The cement base is done, the roof is completed today, now we’re just awaiting delivery of our 10,000-L Aquasan water storage tanks and for the first time ever Bisate Clinic will have a reliable water supply.

Every week we ferry several jerry cans (20-L each) of purified drinking water to the clinic for consumption by work staff and in-patients.  This water is purified at our project house using a truly revolutionary nano-filtration system that we’re field-testing for Seldon Laboratories.  The filtration system is powered by a bike pump which sends the water from an intake bucket up into a pre-filter (to filter the large substrates) and then into a nano filter which cleans the water at a molecular level!  The nano filter is so effective that the water comes out sterile… it’s cleaner - much cleaner - than what we’re drinking in the United States!…I mean this stuff is clinically injectable!!  And it tastes absolutely heavenly.  Today however we forget that we’ve also brought up an unmarked jerry-can of petrol along with all our usual jerry-cans of water…and so the clinic handyman, Joseph, dumps all of these into the clinic’s communal water container.  Whoops!  Joseph immediately realizes his mistake and when we find him he is in a frightful state, apparently convinced that he’s about to lose his job…but we pooh-pooh the error and quite correctly blame ourselves.

Complaint Time: our Cruiser is invariably filled to the gills with locals.  Ours is one of the few vehicles to travel this road and it’s certainly the only one providing free rides to all comers while serenading them with Johnny Cash.  Riding in this overpopulated Land-Cruiser is an experience I’ve come to loath – every frickin day invariably concludes with my tired body being crunched and trash-compacted into the back of this sardine can with a slew of locals whom – and I am NOT disparaging anyone here – but many of whom stink!  Additionally, it is quite frustrating that once the Cruiser is packed like this my filmmaking whims go out the window.  I can no longer ask Laura to stop the vehicle so that I may shoot something…I can’t make everyone just sit there and wait for me!  How bloody rude!  And so the number of magnificent sunsets I’ve forgone capturing because all these fucking people are always in the way will haunt me ‘til my dying day.  But today….Today is different…today I say SCREW IT!…today with the Cruiser as packed full as ever I tell Laura to pull over.  The horizon is a mass of encroaching volcanoes and massive clouds backlit by a spectacular sunset on the loose …and I mean to capture it regardless of how long everyone has to wait for me.  I’m a goddamn artist, god-damn-it!  So Sis pulls over, I jump out and start clicking away with the Super 8mm, and immediately am beset by irritating locals who begin demanding money the second they see my camera – I’m very careful not to point it at anyone and keep explaining that I’ve absolutely no interest whatsoever in taking their stupid photos - and yet the constant din for dollars is hard to ignore – so, I simply bare it for as long as I possibly can and continue capturing most excellent footage of the clouds and mountains blasted from behind by a falling solar orb…and when I can stand the din no longer I grab the camera and scamper back to safety.

Flora and I play some last-minute setting-sun-type-tennis.  She’s somehow improving faster than I am…a concern…may have to very soon resort to trash talking her in order to gain that all-important psychological edge (in sport, as in war, every advantage must be sought).

Laura spends the end of her day cleaning and then re-cleaning the clinic’s communal water tank which we’ve brought back down with us…the smell of petrol is still quite noticeable…she calls our hygiene expert John-Peter for advice, he researches the problem and phones us back the exact ingredients and measurements required to clean it.

My morning tennis lesson concludes and a little tyke who is always hanging around the court asks me for a ride…assuming he means a ride home, I tell him to jump in.  We drive five minutes down a road to the corner where I’ve dropped him before…but this time he points onwards down the lane…having no idea where this kid lives, I drive onwards, following his pointing finger.  We proceed to circle the neighborhood.  Every so often, I ask hano? (here?) but the kid keeps pointing me forwards…so I keep driving forwards.  We pass my house and then make a complete circle back around to the exact same point where we had begun…I look at the kid.  He points forwards again just like before and it dawns on me that this twerp just wants to ride around in the goddamn car!  I open his door for him and politely kick him the bloody hell out.   

Awake at 7am to my third tennis lesson in as many days.  Coach is a young twenty-something punk with minimal English who has, perhaps, improved my game maybe a little bit, I guess.  We end our hour-long session and I await my pickup as ‘Coach’ runs me down the now familiar conversational pathway of “will you buy me a phone” followed by “will you pay for my English lessons”.  Young rural Rwandans begin making these requests the moment they meet you.  There appears to be no concept of perhaps cultivating a friendship or of pursing any sort of relationship beyond that of an immediate handout.  The offshoot is that, to a large degree, this precludes most possibilities of making local friends – it’s impossible to form a friendship when the first and only subject of conversation is how much can I donate to ‘my new friend’.  Young and old here seem quite indoctrinated on the idea that foreigners are nothing but sources of free shit…we’re not humans, we’re ATMs.  In the local view, us giving donations is our only reason for existing, they’re expecting us to exhale cash, and aside from that they’ve no use for us.  So my group of Rwandan friends is severely limited.

I awake in one of my terrible moods.  Don’t know what brings these on…they just pop up from time to time for a day or two.  My acute distemper remains untrammeled as we waste all the afternoon hours hiking aimlessly up and down and across steep forested hills on a wild-goose-chase searching for suitably fat trees to serve as colonnades for our clinic’s new Meeting Area/Temporary Kitchen structure.  Rwandan trees, however, are like Rwandan people – skinny – and we find precisely squat.  My terrible mood does manage, however, to find a great deal about which to be continuously moody about.

Sometimes I wonder what the hell I’m doing here.  Sometimes it just seems that the efforts of one tiny project such as ours can hardly aspire to the level of meaningless drop in the bucket!  If we’re here, if we’re not here, does it matter?  White people come and white people go – rich important people on world-saving missions - but look around and what do you see?  Nothing.  Are we changing anything for the better?  Are we fooling ourselves with superficially short-lasting touchups?  Is our project this year’s trite fad and next year’s forgotten memory?  Are we even wanted here.  In Africa, one seems to hear much about how astoundingly asinine, incompetent, and misplaced the values, goals, methods, and results of these white-skinned Western do-gooder NGO-types truly are.  You frequently hear nasty comments about UN aid workers too…and yet all these major outside organizations must be doing something right, right?  Given the mounds of money and people being thrown at these projects, they must be accomplishing a great deal of good, right?  Right.  Perhaps it’s just the nature of news: bad news travels further, faster, and lasts longer while good news seldom makes it past the front door.  Do we just not hear about the successful projects?  Or do the vast majority of projects simply fail because they’re aimed at ‘improving’ cultures whose traditions, values, and beliefs are entirely alien to these outside do-gooders?  Are these projects inherently doomed to failure due simply to our intrinsically different value systems and utterly dissimilar ways in which we view the world?  We don’t understand them, they don’t understand us; we’re on entirely different playing fields playing entirely different games…I mean it’s not even the same sport.  When informed that UN refugee camp aid workers in Sudan return each evening to $300/night luxury hotel rooms, one’s eyes unavoidably roll…but whether such stories are true, I’ve no idea.  This is just what I hear.  But look around you, what do you see?  Nothing.

Hate these bad moods of mine – actually never noticed until this project what a moody SOB I am – but they are quite decidedly real.  I’ll awake and realize pronto that today is ‘one of those days’ and that is that, there’s nothing I can do to snap out of it, on those days I just try to steer clear of conversation and keep to myself as best I can.

Thankfully my crappy mood lasts only one day.  Awake at 6am feeling fine and drive to Ruhengeri Prison for my first ever Kinya-rwanda language lesson.  Got nothing else to do, so figure I’ll learn the local lingo and hopefully it will help me with my filmmaking.  I park the Land-Cruiser as a troupe of pink-clad, hoe-carrying prisoners marches out the prison gate shepherded along by a guard with an AK-47 dangling lazily from one arm.  Another guard steps over to ask what I want and I try explaining about my lessons while admiring the nasty scar that curls up one of his cheeks and ends just below his eye-socket – how did you get that little beauty mark I wonder.  A twenty-minute discussion ensues during which pink-uniformed messengers disappear and rematerialize through the front gate as the powers-that-be slowly sort out what it is I’m doing here.  Finally, I’m informed that the prisoner who was to be my teacher is presently at his Gacaca (Genocide court case) and thus unavailable.  I’m told to return in a few months time.  Curse my luck!…when and where else am I going to have the opportunity to learn language skills from a bloke who has likely cold-bloodily killed innocent human-beings?  I drive home and make fresh yogurt to dispel my disappointment, I like yogurt – th’stuff keeps me going.

Flora is diagnosed with Amoeba, an intestinal parasite that eats your blood.  This diagnosis officially solves the mystery of why, for some days now, at remarkably short intervals, Flora has been fleeing off to the bathroom – especially conspicuous behavior when one is trying to watch a movie with her.  Bisate’s Lab-Tech, Jean-Baptist, makes the diagnosis and much to the bemusement of locals, Flora (a white girl) fills her prescription at the clinic pharmacy window.  She’s told to refrain from dairy for two weeks, which is music to my ears, as Flora’s yogurt consumption has, as of late, become something of a worry.  Yogurt is a limited resource ‘round these parts and it’s the only thing keeping me from tottering over the brink, so I’m rather protective of it.  As ever, though, Flora is most impressive in accepting the bad news, no complaints, no moping, no lollygagging – a tough cookie is Flora.

We meet an interesting local fellow who apparently is called The Rock-Man because he and his hammer can manually rip through any amount of rock.  We aim to negotiate him into ripping through a good chunk of the hill behind the clinic in order to supply the foundation rock for our new Meeting Place structure.  The guy looks like spun muscle but there’s something in his face I don’t like.

Later, we head off on our 2nd day of tree hunting.  Timber yards are non-existent so if you want a certain type or size of wood, well, you walk into the forest and start looking around.  Today we walk into the loveliest stretch of forest I’ve ever seen.  It’s a deep, mossy, and lush Eucalyptus forest lying at the foot of Sibinyo Volcano, and it emanates a smell so wonderful provocative that breathing becomes like a wonderful dessert…and it’s quiet…it’s the first place we’ve been outside our compound walls where there’s actual peace and quiet…you can walk here and not see or be seen, it’s a strange delightful peaceful unusual feeling.  I could live in this forest.

Nurse Telesphore is told today that his penmanship is crap and that he and his illegible-ways are costing the clinic too much wasted time and money (the Insurance Company won’t reimburse for unreadable figures and the head nurse, Jacqueline, is spending hours per week correcting stupid staff writing mistakes).  Laura’s face-to-face accusation brings the first real battle between her and a staff member.  She claims that Nurse Telesphore is a lazy SOB and insists he could write better if only he tried.  Telesphore responds that he cannot write better, he doesn’t need to write better, and indeed he refuses to write better!  Laura replies that she’s damn near ready to get rid of Nurse Telesphore for good!!  Head Nurse Jacqueline (who has been excoriating Telesphore’s numerous shortcomings to Laura for weeks) selects this moment to bizarrely insist that Telesphore has impeccable penmanship and is one of her very best nurses!!! (to be fair, someone needed to take Telesphore’s side, as Laura’s wrath was about to incinerate the poor bugger).  Laura points out that Jacqueline’s memory is remarkably selective, which I have to agree with if only for the sole reason that the last time we were all discussing Nurse Telesphore was when he had shown up for work reeking drunk - and he had been the only nurse on duty!  Nurse Telesphore is a bit of a fuck up.

Now that our medical volunteer (Dr. Mary) has left, we wonder very much if the Bisate nurses are continuing to actually do their daily patient rounds and patient ‘hand-offs’.  I’m skeptical – today there are three babies on IV-drips and yet I see no nurses in the ward for most of the day and I even notice that one of the baby’s IVs has run dry.  

Aside from yogurt, the sole entity keeping me functional is our adorable cat, Gomi.  Each night she jumps onto my bed, boroughs through the mosquito netting, snuggles into my armpit, and lays her adorable little feline head upon the side of my chest.  I just love her to bits.

Our exhaustive tree hunt has led nowhere and Laura is rethinking things; metal is looking better and better.  The original idea called for a Greek-like temple with thick wooden columns but it may just be the case that Rwandan trees are too darn thin and skimpy!

The fabled Rock-Man disappoints.  He gives us a ridiculous “Muzungo Price Quote” for supplying the rocks for our new Meeting Area foundation.  Even the local Health Animator members laugh when they hear his price quote…and people don’t do much laughing around here, so we take these chuckles as rock-solid proof that Rock-Man is someone we don’t wish to do work with.  Laura explains that she needs the Health Animators help to get fair prices – she tells them that she is happy to pay for everything but that she cannot be the one who negotiates prices – locals see a white face and they immediately quadruple the price tag.  Laura asks the Health Committee to find a Rock-Man.

We depart late and are rushing to the clinic when Laura smacks her head and shouts, “shit, I forgot my stencils!” so we turn around and return to the house to grab her stencils and thereafter we’re back on the road again, rushing up to the clinic lickety-split when Laura once again grabs her head and yells “shit, my brushes too!” so we turn around and jet back to the house to grab her brushes, after which we’re speeding up to the clinic just as before when Laura throws both hands in the air and exclaims “mother fucking PAINT!!!!” so we turn around and drive back to the house again…

Clinic Day.  It’s one of the gloomy days where the weather sucks and nothing goes according to plan.  We’re on the verge of cutting our losses and driving away when Laura says fuck it “I’m going to get something done today”…Laura pulls out her art supplies and starts stenciling in the In-Patient Ward.  This is exactly the type of perfidious, anal, and time-intensive task at which Laura thrives.  The patients and work staff are mesmerized at her work – nothing like this has ever happened She spends the next two hours standing on tip-toe atop a rickety wooden chair while painting the first row of pineapple stencils.  Every other minute she has to step down off the chair to refresh her paint supply and in no time she is dissolving into a complete physical wreck - after stenciling like this for two days she’ll be ready for a retirement home.  Laura, Flora, and Jacqueline also find time to throw up an Alphabet stencil in the Maternity Ward…did you know that in the Rwandan alphabet there are no Q’s or X’s, we had to remember to throw these out!

Flora, Joseph, and Jacqueline III also finish painting a 1st coat on the staff bathroom.  

I’ve shot nothing but time-lapse footage for the past two days.  I do hope the World’s entertained by Laura stenciling at incredibly fast rates of speed…

Extreme fatigue from several non-stop days of non-stop work, we sleep blissfully late and take the afternoon off.  One can feel the emotional and physical stresses steadily accumulating in our minds and bodies – rest days like this are crucial.  In the evening we float over to dine at our friend’s house (Katie & Glen) along with several other scientists from the Diane Fossey Gorrila Group - dining with them is always such a treat, especially as Glen is an absolute cooking fiend and is audaciously adept at putting on a true feast.  Tonight, however, our delectable meal of Indian cuisine is destroyed by a phone-call: an injured orphaned gorilla has been found in a nasty Congolese snare and it’s being rushed in right this moment for medical attention (There are only about 700 of these Gorillas remaining in the world and half inhabit the extremely unpleasant side of the Congo/Rwanda boarder) - half the room vanishes in seconds to deal with this disaster… The rest of us, rather stunned, recline upon Ugandan sofas around a roaring fireplace and wonder aloud about what’s happening.  We learn later that one of the poor creature’s fingers had to be amputated and then we learn that this failed to halt the infection and so the entire hand had to be taken off to the wrist.  The Gorilla will be spending the rest of its life here in captivity.  It does pay to be a Mountain Gorilla that lives on the Rwanda side of the boarder - this one was brought in from Congo where scenes like this are too common.

I’m sick and tired of having no furniture.  For too long now, I’ve been editing and logging my video footage from a lying-down position on my bed with the computer perched upon my chest, and this is just an insufferably undignified arrangement.  So I scribble a design for a desk that’s custom fitted to my body and go off to show it to a Congolese furniture maker who works down the road.  My design includes a semi-circular cutout of the middle-front part of the desk-top so that it will perfectly wrap around my waist-line and allow me to really pull it right up to myself.  I hand over the design with high hopes but low expectations.

Clinic Day.  Flora & Jacqueline III put a second coat of paint on the staff bathroom.  I shoot more time-lapse photography of them accomplishing this.  It’s official, I am indeed now actually shooting paint drying – and I must admit that things have become rather dull of late.

A poor woman miscarries and has to recover in a maternity room full of mothers who are all holding their healthy newborns.  

Today we douse the patient toilet in petrol and burn it to the ground.  No more squatting over ill-defined floor cracks (there’s no designated ‘hole’), no more lifting the door off the ground in order to close it, no more shit-strewn floors...  The pit beneath is apparently close to overflowing as well, and so Laura finally declares the whole thing an unbearable health hazard and she orders its elimination.  In scant order the clinic handymen, Joseph and Leo-Dormil, have stripped off the toilet’s asbestos–coated roofing sheets and two women have carted off the wall timbers atop their heads (one almost brains the infant tied to her back when the pyre of wood atop her head nearly falls off)…the remains of the toilet are burnt to a crisp and a fence is thrown up around the site which will be sown with lime and allowed to sit fallow and undisturbed for a year.

 Everyone seems rather stunned at the bonfire.  It turns out that the communication process beforehand wasn’t so good – some of the nurses are wondering why the fuck have we just burnt down the patient toilet!  But Laura explains again about destroying a health hazard and when they hear this they get it “oh you didn’t burn down the patient toilet” they say “that was just hygiene”.  Laura shakes her head in wonder.  All the dissembling and destruction is filmed in Time-Lapse and should be quite visually cool.

Am trying to weasel my way into shooting a few births.  I want to get my camera right in there and see those little heads popping out and whatnot.  After all, the CCHIPS program is focused on child and mother health…and what’s more symbolic of this connection than the act of giving birth?  But no luck yet.  Whenever I mention this desire, the response seems to be an incredulous chorus “of course not!”  Maybe if I pay someone though…

Ok, cannot avoid this topic any longer…cannot tell you how fricken sick I am of being stared at, ad nauseum!  I don’t mind a bit of it, mind you,…but after months and months it’s starting to eat away at my soul.  Ok, I see a pretty lady or a twelve foot giant and I take a peek, sure, I’m human, but I peak and (here’s the crucial point) then I look away and quickly too!…as Seinfeld once said “it’s like looking at the sun, you take a peek and then look away!”  We Westerners are accustomed to looking at each other, of course, but we seldom stare at one another, especially when we’re three feet apart!  Not the case here, children and young adults come up to the Cruiser windows in an endless stream and they will stand and just stare at you for 10, 15, 20, 30…minutes!  Sometimes they even do the squish-face thing against my window, which is indeed even more disturbing.  Apparently I am absolutely fascinating to look at!  As best I can I try to ignore these gawkers but then they’ll just resort to tapping on the glass and climbing on the’s like I’m an zoo animal and the point is to pound the glass until they get some sort of reaction out of me.  From a Western standpoint it’s massively intolerably impolite behavior– but it’s the status quo here.

Today Laura has the genius to ask our housekeeper, Alice, to move all of the house-hold’s bedding materials out of my closet and into the closet in the big empty bedroom - so I now have oodles of extra space and am beside myself with glee.  My bedroom, you see, is about the size of a van so the extra space is appreciated.

On the way out, I hear John-Baptist has just diagnosed a 23-year-old girl with TB.  

Clinic Day.  I wait forever for Laura to finish dashing about Ruhengeri on a dozen different chores and thereafter we head up to the clinic around 3pm.  

Today the clinic conversation goes straight down the toilet.  Laura and our water/waste expert, John-Peter, discuss whether the clinic’s new toilets system should be a simple open pit latrine system or a plastic septic system (which transports the human waste from toilet to plastic containment unit via pipes).  At first nod, Laura prefers the septic system - it seems the cleaner, more hygienic, less smelly option, and also the most familiar option for us Westerners.  However, the discussion keeps returning to the fact that the local population has no experience with a septic/piping toilet systems and also that in lieu of toilet paper the locals use a wide variety of sticks, twigs, leaves, and rags to wipe themselves.  Laura fears that this refuse will result in a pipe-fed septic system that is perpetually clogged.  Installing such a system would therefore require that we also alter long-established and very basic local behavior...and even if we had the trained personnel to do this (we don’t) we cannot think of a single locally produced wiping alternative that could be used and that wouldn’t clog the system...I mean how much behavior change can one accomplish?  Pit latrines, on the other hand, cannot become clogged and require no behavioral modification or education to use properly.  Pit latrine it is.

We discover an overtly inebriated man digging away at the hill behind the clinic, but very much on clinic property, and beside him is a rapidly widening pile of unearthed rocks.  He’s pounding on rocks and singing like a drunken sailor.  Laura asks a staff member what the devil does that man think he’s doing!  When he spies us, the Drunkard lowers his mallet and comes staggering, shouting, and swaggering our direction…we quickly learn through translation that he’s yelling at the nurses not at us and he’s lecturing them that “you may know all about medicines and health clinics, but I, The ROCK-MAN, know all about breaking though these rocks!!!”  After much confusion Rock-Man goes back to work while we learn that he is the guy the Health Committee has procured to supply rocks for the new Meeting Area’s foundation.  I look over and the man is tearing through mounds of volcanic boulders faster than an industrial mining drill.  Holy Shit!

The old outhouse we burnt down yesterday is still smoldering.  I want to shoot the birth of a baby...but everyone still thinks it’s impossible.  An amazingly beautiful day.  We arrive late so the sun is shining nearly horizontal and everything is gilded with a rim of beautiful gold light and then dark shadow.
A gang of village children is bedded down like vultures on the clinic’s back hill…awaiting our departure so that they may pounce upon the Clinic’s water supply.  There are only two water spigots in the whole town and we got one of them.  Mainly they’re small kids and girls; John-Peter tells us that these are the ones who have been muscled away from the main town faucet which, in dry weather such as this, is besieged by townsfolk and fights regularly break out and the strongest get dibs.

I lose my god-damned Allen-Key wrench…I’ve lost two others just like it on this trip and this one was my last…without it I lose the use of the second stage of my tripod!  Those familiar with the cinematography world would correctly diagnose this loss as an utter and complete horrible disaster…but later in the day John-Peter by some miraculous stroke of fortune finds it.  I had showed him the general area where I thought I might have lost it and then John-Peter just stands there and looks at the ground…and he keeps doing this for what seems like half the day…and then he bends down and picks it up.  If there’s one thing that Rwandan’s possess in excess…its’ patience!

Spend the day at home logging video footage and overeating.  Am reading a great Bill Bryson book about the history of the universe and so I’ve taken to spouting off amazing facts aloud to everyone in earshot whilst reading – as this makes me feel incredibly smart.  Laura and Elie spend the day discussing and translating CCHIPS’ yearly action plan.  In the evening, we go to a lecture on gorillas at the Dian Fossey Office and afterwards we surf the moderately speedy Karisoke Office Internet for an hour.  I chat with brothers Ryan and Karl while downloading Stuffit-Expander and opening an AIM account and downloading Adobe reader…and I haven’t done this much downloading in AGES!  And it feels AMAZING!  My little brother, Ryan, is a college sophomore and is aburst with ideas, optimism, and money-making schemes.

Gabby got no sleep last night.  Interesting Fact - if Gabby awakes during the night and sees a lit light bulb, he is rendered incapable of going back to sleep for the remainder of that night…last night he awoke and saw a lit light-bulb…today Gabby is a zombie.

Have grown so mentally jaded that I’ve started filming our diners in time-lapse, 1 frame every 60-seconds.  Why you ask?  Well, I’m an artist, that’s why!  Tonight at dinner we discuss cultural experiences and realize we’ve all withstood a great many extremely painful, awkward, and uncomfortable episodes all in the name of ‘having a cultural experience’.  I propose that painfulness is the dominant trait of such activities and sponsor a bill to table all future cultural experiences.  One culture is more than enough for me, thank you.

Go for my morning run.  Cold shower…(Laura’s apparently got a monopoly on all the hot water around here).  French toast flavored with artificial almond and vanilla extracts doused in Vermont Grade A Maple Syrup, with a strong glass of native Agasha juice (three parts concentrate, one part water) – now THIS is a breakfast!  I’m psyched, pumped, and ready to go up to the clinic.

Behind the clinic we find that drunken bellicose Rock-Breaker-Man is still breaking rocks at an alarming rate.  Laura takes Window-Screen-Man on a tour of all the clinic windows and we meet another man who claims to know where to find pumice and who even leads us to a nearby cliff of the stuff.  This pumice may be what we use to create the bricks for our upcoming New Kitchen building (regular wood-fired bricks are outlawed in this country due to rapidly dwindling timber resources).  In other news, Laura has brought a new nozzle for the Clinic’s water tap but cannot get the old connector ring unscrewed from the old nozzle…she tries dunking the old nozzle into a jar of coke for a while to soften it up but no dice.  

I am sick to death of snotty-nosed kids pressing their mud-encrusted faces against the Land Cruiser windows in order to stare at us endlessly.  I mean how fucking impolite is that!  And whether you say hello or bugger off, it doesn’t mater a bit, they just keep their filthy mugs pressed on the glass staring at you like they’re ogling the fornicating serpents at a reptile zoo.  Ok, that sounds harsh, I do love the kids here - a very innocent and adorable lot – and I don’t mind people staring at me – it’s just when they stare for several minutes and then several more minutes – all this starting just starts to add up and it starts to get to you, plays on your nerves, drives you bonkers.  Even when you scream at them in Kinya-rwanda to stop staring at us for Shit’s Sake!  They just keep on staring!  Why don’t their parents teach them some god-damn manners for Christ’s Sake!  Fuck!  And you can’t stare back because these people can stare you under the table – there is stuff deep in these eyes that a westerner cannot look into.  Bring Nietzsche to mind: “gaze for long into an abyss and the abyss will gaze also into you.”  Today is national water day.  Did you drink some water to celebrate?

Elyse, my young punk tennis coach, is a no show at our practice this morning, so I spend half an hour worsening my serve until Flora shows up and we play for a bit…but she’s distracted by a desire to be lounging poolside at EER Hotel down the street and I’m distracted by my horrendous tennis playing.  She’s ahead and winning for the entire game until fortune shines upon me in the form of a distracted scorekeeper (the great thing about Ruhengeri Tennis is that for $1 you get a ball boy and a score keeper!): anyways, a loss for me, is somehow magically transformed into a tie and then - after I complain to the kid in the scorekeeper’s seat – I am declared the winner!!!  WOO-HOO!  The ol’ winning streak lives on!  Flora is nonplussed.  So we drive to the pool and lay out in the sun, which immediately vanishes behind a sky-load of long dark storm clouds.  After thirty minutes of this shadowy intrusion we are freezing and return home; me to eat yogurt, Flora to prep for a trip to Kigali.  

With my yogurt I mix in the very last of our Vermont Pure Grade A Maple Syrup…only God can save me now.  

Maybe a breakthrough idea for the film!  I’ve been looking for a through-line on which to base some sort of narrative development - what I’m currently capturing day by day seems to form so many separate random narratives…but last night I thought why not follow the babies?  The clinic should be seeing 55 births per month if it was hitting it’s goals, but it has been hard put to see half that number…perhaps I can make this ‘baby-shortage’ a center point of my film – something upon which to hang everything else.  I’m a loon.

A Rwandan Wedding Day.  Before marrying a stone-faced couple, the preacher rants for half an hour against the evils of homosexuality, explaining that HE has found the smoking biblical gun that PROVES homosexuality is a sin…and this is that Eve had… BREASTS!  And as he says this, the pastor emphasizes his proof by cupping his hands in front of himself as if he’s hefting his own two large imaginary breasts - explaining that “there you have it, verifiable non-refutable un-equivocal PROOF that homosexuals are demons”.  I would have captured all this on video and it would have been one of the more interesting segments of my documentary, if only I had understood what he was saying when he was saying it …however, I understood and filmed nothing because I at the time I took it for granted that boring, long-winded, wedding sermons are a universal constant.  Not true though.

The sick ward is filled with patients, mostly babies on IVs suffering from diarrhea and vomiting.

Rock-Man is still pounding away behind the clinic.  The man is a machine and quickly is disappearing behind multiple piles of split boulders.  Two other blokes seem to be helping him…though mainly through moral support, as their work, it appears, tilts mainly towards working their mouths and nothing else; one Rock-Man, two Pebble-men.  

Our two clinic handymen, Joseph & Leo-Dormil, burn a huge pile of medical waste in the pit behind the clinic.  Everything’s dumped in this pit – syringes, bottles, bandages, body parts, and today even a moldy old mattress.  Joseph douses everything with gasoline and Leo tosses in the match.  The smoke billows over the clinic grounds, passes directly through Rock-Man’s work area ten feet away, and envelops the clinic beyond.  Everything smells plasticky and strange.  I feel nauseas and scamper upwind.  The patient and maternity wards’ windows are flung wide open and the smoke pores into both but no one seems to mind.  Part of the CCHIPS plan is to build an incinerator because burning medical waste in an open pit ain’t hygienic…and the pit cannot incinerate anything but just sort of chars everything into a fried amalgam and tomorrow children will play in the pit and pry up the half-melted glass vials and all the other burnt bio-waste that attracts their eye.

 I am so aggravated with all these damn Rwandan kids…hollers of “Muzungo” (“Foreigner!”) and “Agachupa” (“bottle”) and “Franga-franga” (“money) plague us wherever we go.  The children beg en mass and the culture seems to promote this behavior.  By most worldly standards I’ve encountered the kids here are a grossly impolite bunch (by comparison I’ve been to equally poor places in China, Vietnam, Thailand, Indonesia, Malaysia, and Egypt) and I’ve never encountered such a weird sense of blind entitlement and expectation and acceptance when it comes to screaming at foreigners for handouts.  Children in this region seem pre-installed with a beggar-type mentality when interacting with foreigners.  This sounds harsh but it’s the harsh truth.  Partly the fault of the Mountain Gorillas I suppose, as all tourists come to this part of Rwanda for 24-48 hours to see the Gorillas and I think many of them tend to thoughtlessly shovel loads of shit out their Land Rover windows to the childish hoards without giving much thought to the long-term consequences.

Out of nowhere the Clinic Titular (Head Nurse), Jacqueline, shows a dumbfounding burst of actual leadership action regarding the clinic staff.  She is pissed at Telesphore for missing work on Friday and she wants to…(get this)….do something about it!!  This comes a week after Laura’s tirade against Telesphore’s penmanship in which Jacqueline defended Telesphore as the embodiment of responsible competent nursing!  (fact: we all know he sucks)  My oh my! but how soon the tuneth doth changeth.

It’s my first tennis lesson with Ruhengeri “Club Pro” Rasheed - the man runs me ragged - so ragged in fact that our session ends with me on my knees begging for clemency.  Elyse, the young punk who had been my coach (a very bad one) is non too happy with the personnel switch.  When I arrive, he tries to worm his way into displacing Rasheed but I put the kibosh on that.  NoGoMoFo!  

I walk home from my lesson, stopping to purchase a humongous 3-foot branch containing dozens upon dozens of little yummy bananas for less than a dollar, a gift that I’ll take up to the clinic today for my friend, Nurse Emanuel.  The banana woman doesn’t speak English so a man suddenly appears who speaks maybe two words of it and he assists with our negotiations and afterwards the chap’s after me for a ‘finder’s fee’.  I laugh and pay him and head home and make the mistake of offering a banana to a neighbor child…before I know what’s up a dozen excited infants stream out of our neighbors courtyard and ransack my banana branch.  Don’t mind a bit as I know their parental situation is a bit of a mess at the moment and we know these kids aren’t always getting enough to eat…

At the clinic, Laura and Elie escort Nurse Telesphore into a private room and read him the riot act.  They show him a letter outlining his chronic absences that will be sent to the district signed by both Laura and Jacqueline.  Telesphore denies everything and complains that the work schedule is unfair.  Shape up or ship out is Laura’s one simple response.     

I hold my first interview with Clinic’s lab tech, John-Baptist.  We hold it in the courtyard of his house.  Typical story.  His life is rough.  He doesn’t earn anywhere near enough money.  He’s trying to put a brother through school.  Childhood polio has placed him permanently on crutches and the cost of maintaining his wheelchair is everlastingly depressing.  He’s a lovely man though who we often hear singing aloud as he works and he is a natural soft touch with kids.  200 yards away from us, my Super8mm camera ticks away at 20 second intervals in what is hopefully an awesome recording of a setting sun plunging behind a mist-shrouded mountain…Ahhhh Africa!

A quiet day at home.  Rainy season has begun and the cat has taken up permanent residence beneath my pillow.  

We have a bit of fun during our standard meal-time time-lapse film shoot and begin circling the table at a snails pace in our chairs as the camera clicks away at 1 frame every 5 seconds (sorry but here in Ruhengeri we ravenously suck dry any bastardized form of entertainment we can possibly sink our deprived fangs into).  I follow the meal with more time-lapse fun starring my nearest and dearest snugly friend, Gomi the Kitty Cat!  YEAH!  Without Gomi and Yogurt I would be a lost man with only SMPs to keep me company.

Anyone ever wonder why ‘minute’ and ‘minute’ are both spelled exactly alike!!!