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

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

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

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

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

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


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

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


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

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

Galileo Crying lonely For you. I promise.

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


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

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


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

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

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

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

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

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

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

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


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

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

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

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


2/20/07:
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.


2/21/07:
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.


2/22/07:
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.


2/24/07:
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.


2/25/07:
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.


2/26/07:
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.


2/27/07:
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.


2/28/07:
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.


END OF FEBRUARY BLOG