Land of a Thousand Hills

July 26, 2007 – Rwanda

“We wish to inform you that tomorrow we will be killed with our families” by Philip Gourevitch.

If you don’t know about Rwanda, you have to read this book. Even if you do know about Rwanda, you have to read this book.

From 1995 to 1998, the author Philip Gourevitch, a staff writer at The New Yorker, dedicated his life to learning about Rwanda and understanding the events surrounding and including the main genocide in 1994. He conducted countless hours of research and thousands of interviews with Rwandans. The result is an incredibly comprehensive account of the Rwandan genocide: its origins, the major players, and the aftermath.

Throughout our stay in Rwanda, the voices in this book have intermingled with the stories from Emmanuel and Amos (two genocide survivors, and our drivers during our stay here). Without these three threads, I may have seen Rwanda as just another East African country, but the term “just another” always makes me cringe (especially in this case).

In Kigali, you look at the nice roads (a development project initiated by Germany three years ago), the new buildings, shops filled with people going about their daily lives. You think, what? Neighbors were hacking at each other with machetes just thirteen, even fewer, years ago?

But then you drive past a gacaca—a local court—where ten people in pink prison uniforms stand in front of a community jury. Every week, communities hold one gacaca to try convicted genocide perpetrators. The aim is not to give everyone the death sentence or life imprisonment. Many of those who can not be counted as genocide masterminds, but killed nonetheless, are given community repair projects and are integrated back into the society - but was does "integrate" mean? It’s not uncommon to see killers living beside those whose families they killed, which is enough to give anyone the chills.

Sometimes I don’t know what makes me sicker—to know that neighbors killed neighbors or to think about the international response to the genocide.

In fact, I don’t know of few other instances I have been so disgusted by an international response to crisis.

Not only did the French continue to supply arms to Habyarimana’s Hutu Power throughout the genocide in 1994, but after the war, they funded refugee camps that were rebuilding Hutu Power groups who were turning around and starting another genocide across the western border. That no one spoke out against this is more staggering than the genocide itself.

In Philip’s book, he interviews Kagame, the former leader of the RPF (the Rwandan rebel forces) and current Rwandan president. Concerning the perpetrator-filled refugee camps in former Zaire, I can’t agree more with Kagame when he said, “I think we should start accusing these people who actually supported the camps, spent a million dollars per day in these camps, gave support to these groups to rebuild themselves into a force, militarized refugees. When in the end these refugees are caught up in the fighting and they die, I think it has more to do with these people than Rwanda, than Congo, than the Alliance. Why shouldn’t we accuse them? This is the guilt they are trying to fight off. This is something they are trying to deflect.”

When I was in high school, former Secretary of State Madeleine Albright came to speak to us. I remember one of her first remarks was regret for failing to respond to the genocide in Rwanda. In fact, she was one of the first western politicians to apologize publicly to the Rwandans. In 1997, she gave a speech to the Organization of African Unity in Addis Ababa, where she said, “We, the international community, should have been more active in the early stages of the atrocities in Rwanda in 1994, and called them what they were—genocide.”

She was soon followed by President Clinton, who became the first Western head of state to visit Rwanda following the genocide. In fact, Clinton has been very active in supporting Rwanda in the past few years, and we visited one of his primary collaborators: Paul Farmer’s Partners in Health (PIH) project. We visited their hospital near Rwinkwavu which serves 150,000 Rwandans. The hospital was already here when PIH arrived, but it was in shambles and barely churned through ten patients a day. We looked at before/after pictures along the main corridor and found out that they currently process 140-160 patients per day.

PIH’s biggest innovation on health care for the poor is their cohort of one thousand community health workers. These villagers have regular training at the hospital and become paid employees of PIH. They are trained to educate the population about health issues and family planning; to be able to diagnose the major diseases that come up again and again (TB, malaria, HIV, and malnutrition); and to make sure people take all their medications at the right time and in the correct dosages (which is essential to preventing resistance).

Although Paul Farmer is most famous for his work in Haiti, PIH is also operating in three African countries: Lesotho, Malawi, and Rwanda. PIH’s community health workers are an expense that most hospitals claim they can not afford. And yet, here in Rwinkwavu, community health worker intervention helps in early diagnosis and drastically reduces the rate of patients falling ill again after treatment. As pioneers in this field, PIH is doing some cost/benefit analysis to provide a model for other healthcare providers, though their emphasis is really on doing good work than over-analyzing it.

We also had a chance to see the new training center that PIH is building up behind the hospital. Once completed, the training center will have dormitories with fifty-person capacity and classrooms that can welcome many more. The training center will be a site for teaching the community health workers, for training farmers new cultivation practices, and for offering the community the opportunity to attend other nutrition and health courses. This is more evidence of PIH’s amazing holistic approach to poverty alleviation.

We sat down for lunch with Michael, one of PIH’s main physicians, and Margaret, a representative from The Clinton Foundation. It was a short lunch because we had an appointment with the Millennium Village Project (MVP) in the early afternoon. In our limited time, we learned more about a recent project initiated by PIH and Harvard’s Business School to write about the huge deflection of charity funds back into the hands of foreign aid workers. In particular, they are focusing on USAID and the fact that on average, only thirty percent of funds are used for community projects.

As we drove to the MVP office, I saw several wells and pumps along the road, but all seemed to be new and unused. We soon learned that the government has been trying to expand the water distribution network, but that in the last one and a half years MVP has been operating in Rwanda, little progress has been made. It was interesting to hear that MVP itself has not taken an active role in well-building initiatives. At the same time, we visited a farmer who has planted one hundred fruit trees on his farm (with seedlings from MVP), and travels ten kilometers to get enough water to feed his plants. I can’t help but wonder how sustainable this project will be. Still, most of the one hundred trees appeared to be healthy and the farmer is very dedicated to caring for them. He used banana tree shoots to protect the earth around the trees and retain moisture.

MVP Rwanda has forty people on staff. Their first priority is food security and they work with five hundred model farmers to pioneer improved farming practices to increase the productivity of the land. Their second priority is health and they have made huge strides to improve local health care centers. After visiting the farmers, we drove to a nearby health center. Before MVP intervened, the center had just three nurses. Now, the center boasts fourteen nurses and serves a community of 25,000. We walked into ward after ward of patients, beginning in the maternity ward, where we visited a young woman who was pregnant with her fifth child. It was a very safe and clean environment and all her friends were there to keep her company. It was dinner time, and we felt a bit awkward interrupting all the patients as they ate in near silence. We didn't stay long because the sun was setting and our own stomachs were beginning to growl.

* * * * * * *

Rwanda is a land of red earth, red bricks, red homes. Even blue buildings, green buildings, they all have a red stain that creeps up the base of their walls. The dust is carried upwards by wind and by little red hands but never goes higher than two feet.

Red dust creeps up, but red blood drips down. It's strange to me that the only visual cue that reminds me of genocide is a natural one, when genocide is so unnatural.

In some ways, I think my brain is trying to reconcile what I see at genocide memorials with the new Rwanda that surrounds it and erases the traces. But it's hard to erase what we've seen.

A patch of blood on a church wall has baby bloody tendrils that slip down to the cement floor. Perpetrators would throw babies against the church walls claiming that if they didn't, the children might become the next Kagame (leader of the rebel RPF forces). The alter cloth is stained red and a path of bullet holes leads to a Holy Mary who miraculously stands unharmed beneath a bullet-holed roof and grenade-damaged supports. It makes me sick when I think about church leaders telling Tutsis to gather in the church and then deciding to kill them. I honestly don't know how anyone in Rwanda is still religious.

We went below ground, into the mass grave behind one church. Thousands of skulls lined the shelves along a narrow passageway beneath the earth. It felt claustrophobic
and I just wanted to get out.

It's hard to look at such things, but I do think it's important...particularly for younger Rwandans today. We visited the big genocide memorial in Kigali, which was very well done. Currently, the genocide is not taught about in schools, but the genocide memorial staff are helping facilitate discussions on how to start including this important part of Rwandan history in the education of their children to make sure it never happens again.