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.