August 31, 2007
Petits Plaisirs
“This is the best kind of voyeurism; hearing joy from your neighbors.” - Chuck Sigars
(August 12th) Nyamirambo is the Muslim neighborhood of Kigali. There are two mosques, lit up with white and green fluorescents so they look somewhat like a UFO at sunset. There is a valley on either side of the main strip, and numerous tailors shops. There are “sports stores” with knockoff Adidas bags, where no one seems overly inclined to sell things, and instead they gather passersby for the latest soccer match. In the alleyways people burn piles of rubbish at night, and kids stare transfixed in the glow of the fires. They create jungle gyms out of the stacked crates, and the fruit vendors shoo them away with palm fronts and the occasional tossed rotten wrinkly passion fruit. The samosa vendors walk around with their greasy cargo in plastic clear boxes on their heads, and people chew gristly “brochettes” or goat kabobs.
I realize that I have ignored Rwanda’s vivacity in this blog. Rwanda is in some ways lacking in the same liveliness (or chaos) found in many other African countries. But compared with, say, Newark, or anywhere else in the grey concrete slab of the USA, it is an incredibly colorful and lively place. You get the impression that everyone is living with one foot in the grave, but I think that this might be more impression than reality. When I run around Kacyiru I end up with a hoard of little troublemakers following me, their jelly sandals flapping noisily against the hard-packed earth. I get Patience, our elderly neighbor, who grabs me as I run by, muttering things in Kinyarwanda and trying to roll up my running shorts. There are fourteen-year-old kids in the neighborhood learning to ride their big brother’s motorcycle. There are they younger children who roll up their blue school uniforms and create a gymnasium by piling the sand intended for road construction in a heap and making a bench-horse with concrete blocks. They hold their own mini-Olympics for backflips, sending sprays of sand into the air with every landing. The have perfect form and perfect glee, with their wrists bent in that typical gymnastics splay.
There is Rwinkwavu, where Partners in Health has created something out of nothing. The before and after pictures scattered throughout the halls show the old colonial hospital and the new wards, the old sickly patients and their new selves. There are nutritional support gardens, and a big foundation for a new building. Paul Farmer is proudest of the goldfish pond… when we arrived, there were roughly 20 people crowded around the zen-like pond poking at the fish and floating plants. Dr Farmer believes that public spaces for poor people deserve the same aesthetic as those for rich.
There is Akagera, the game park, which is Rwanda’s attempt at tackling a bit of the safari market. Eastern Rwanda is flatter and more savannah-like, with hills and grass and flattened shrub-like trees. The views are expansive and grand. The landscape seems so stereotypically African that it is almost cliché, and yet you can’t help but be awed.
It sounds trite, but of course the people are Rwanda’s most precious asset. My host’s brother regaled us with stories of his childhood troublemaking and strict catholic school headmistress, complete with mimicked gestures and sound effects. There is Isobelle, the Grande Dame / secretary of the national network of people living with AIDS who gave me story upon story of women’s successes in treatment, and who regales me with the tale of how she found her support group as though it was how she met her husband. There are the eminently reasonable WE-ACT trauma counselors, who not only deal with their own past but the pasts of thousands of others with an admirable grace, humor, and openness. These are women who have had nothing but the worst in life, and still are dead-set on saving the world. They are curious and polite and humorous. They are tri-lingual. They are stylish and sassy. Nowhere is Rwanda’s resilience more evident.
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What, exactly, is Caitlin doing in Rwanda?
(August 3rd) I have been delinquent about updating this blog. This is mostly because I have been busy, but it is partially because I have had a hard time coming up with something to say, not for lack of material, but for lack of insight. There is no sense to be made in Rwanda, and few conclusions to draw.
I have noticed, however, that I have been negligent in explaining what I am doing here, and what my internship involves. I work for WE-ACT, a group that does HIV-related care for women who are positive as a result of rape during the genocide. They also have a family program, income generation, peer education, and numerous other related programs. I have been working in the peer education department on modules on gender and HIV, gender-based violence, post-trauma and psychological problems, and community mobilization. I take materials from the existing Rwandais materials, the Hesperian foundation, other NGOs, and numerous other sources and compile them into one enormous and growing document. Then I edit for language simplicity and continuity, add photographs, and do lots of research into the Rwanda-specific components. This is usually information on available services, specific practices, coping strategies and social norms. I was hoping to get the chance to rigorously test the modules, but that is apparently not in the cards… they are currently about 130 pages long in total, and I have a lot to do this week!
When they have been finished and field-tested, the modules will be sent to the Centre National en Lutte le SIDA (the national center for the fight against AIDS). Hopefully they will be reviewed an approved for use as a national curriculum by anyone who wishes to use them. My boss and I have also been lining up partner organizations to use these modules. So far it looks as though the national network of people with HIV, the national nurse’s network, WE-ACT, the UNHCR subcontractors who work in the refugee camps, several of WE-ACT’s partner associations, possibly an association that does work with prostitutes, and possibly by two groups in the Democratic Republic of Congo (Action AID and HEAL Africa). In addition, I wrote a small report on gender-based violence in the North-Kivu district of Congo, as WE-ACT may be starting programs there.
I think the most interesting part of my work here has been learning about post-traumatic stress disorder, and its treatment. As one of the modules focuses on this, I have spent some time with WE-ACT’s trauma counselors as they interview women. This is obviously rather emotionally taxing. Trying to relay these stories in any but the most superficial way is practically impossible. I feel the need to retell these stories, at the same time as I recognize that they are personal and confidential and painful. Furthermore, suffering does not make for good literature. Nothing I had read before coming here prepared me for the reality of hearing these stories from people’s mouths, and I feel it is beyond my capacity as a writer to relay them in any meaningful way. As I was working on the section on ”compassion fatigue” (PTSD symptoms from hearing other people’s trauma stories) I began mentally checking off symptoms, and I decided to travel to Uganda and the DRC to get some space.
WE-ACT is starting a PTSD program with selective serotonin reuptake inhibitors, or SSRI’s (like Prozac). I did some research into how to get these medications cheaply from Indian manufacturers or through the International Dispensary Authority. Delphine, the patient and friend mentioned in earlier blogs, is in need of Prozac. While I was in Uganda I purchased a years worth of these meds for her so that she might have a supply before WE-ACT starts the programs. The dearth of psychological medications and services for survivors in Rwanda is appalling, and the number of people who have used “cost effectiveness” as an excuse for why good psychological medications are not available is horrifying. The cost of generic Prozac is roughly $25 dollars per person per year, and the impact that this medication can have on the lifestyle and work potential for a PTSD sufferer is extraordinary. Getting medications for Delphine was perhaps one of the most rewarding parts of my experience here. It has affirmed in my mind that I really value the individual interaction in international work, and that I really do want to go to medical school one of these days.
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Betwixt the tealeaves and gorillas, Rwanda has a macabre industry: genocide tourism.
(July 26th) At Ntarama I found a pass card. It had holes in it, the photo was torn off, but the boxes next to Hutu and Twa were empty, and there was a small innocuous looking X next to Tutsi. This was amongst the relics left in a room that had been used to burn those that were alive, though injured, after the massacre. It was scattered on the outskirts with some other debris, that looked at first like sea refuse: a pipe, a card, and the gentle almost unrecognizable curve of an iliac crest… a half a human pelvis. My friend was literally standing on the card when I found it, and I hesitated to pick it up. In the holocaust memorial these relics are behind glass. At Ntarama they are haphazardly labeled with magic marker, or ignored all together. The shoes hit me hardest: the Sunday’s Best, stained in blood, still showing the “size 39” and inner pink tag. The sheer quantity of relics of the genocide is intimidating. The attitude seems to be, “Why bother cataloguing pains”? They are too numerous to quantify. They are too present. Cataloguing gives a degree of safety and disconnect. So many people in Rwanda do not want that, they want the gruesome and real reminders. Furthermore, these memorials have become a considerable tourist attraction.
Walking outside of the crypt at a nearby memorial, Nyamata, I treaded carefully through the small purple flowers strewn like a connect-the-dots image on the soil from a flowering tree above. Purple is the color of genocide remembrance. I looked at these constellations, compared with the constellations of shrapnel and shell holes in the tin roof of the ceiling of the church. They holes and the flowers seemed equal in number and in size. I couldn’t help but think that maybe they came in pairs, a flower for a life, a hole for its loss: maybe there is some accidental symbolism in Rwanda. The femurs in the crypt were stacked in the bookshelf-like spaces. Walking out I saw the stacks of firewood at the school next door, and their mottled bark resembled the mottled color of the unpreserved bones. I understood Delphine’s PTSD considerably better after seeing these memorials: the aesthetic reminders of terror are all too evident in the mundane.
There is a woman interred at Nyamata. She is not known by name. She is in a coffin to herself with a stick still in her vagina continuing to her abdomen and all the way to her chest. Her baby shares her coffin. She has an unusually small amount of company in her final resting place, compared with the usual 20-30 skeletons per coffin, expressly because of the gruesome mechanism of her death. And I think of that stick, still woven through her bones, and wish that her tombstone had a name. But names are worthless currency, and at a certain point it becomes both unreasonable and impossible to find a measure that can explain the vastness of loss of human life.
There are no answers in Rwanda. One could study the specifics endlessly, and find no ergot in the bread and no lead in the pipeworks. Even if these scientific answers did apply, they would be insufficient. Likewise, our explanations of the social and historical factors fall short of complete. One could look for explanations and find the only one available in the intelligent, structured, and capable Rwandan environment: depravity is only human, and otherwise good people are easy to frighten. The examples of genocide are numerous, and there is no equation that describes perfectly the precursors to them.
Leaving the memorials we ran into several prisoners being taken for a Gacaca trial. Gacaca is the local court system developed to deal with genocide perpetrators. The prisoners are dressed in pink jumpsuits, a change from the black jumpsuits they used to wear that were considered too macabre and frightening. They are treated casually, and they are only mildly guarded. Try as I might I could not connect one of these faces with the tombs and the bones. Despite seeing the relics, this place remains entirely unreal to me.
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July 05, 2007
Kiziba
In western Rwanda the collines (hills) become mountains, and the mountains drop off suddenly to a placid and sheet-like grey lake called Kivu. The grey contrasted with the green, and the perpetual mistiness, is less appropriate for an equatorial African nation, and seems like it belongs instead in the Adirondacks. Only at close distance does one begin to see banana fronds and terraced tea farms, and mud-brick houses built into the hillside. Nothing is flat. People make do with what flat territory they can find, and soccer nets are set up in the blank spaces in the S-curves of the perilous roadway. The mountains converge into harsh valleys, and ascend again like a roller-coaster.
The slick vinyl seating on the buses adds to this amusement-park feel, as all four people seated abreast slide inexorably into one another as the buses hurtle around corners, none-too-aware of the white dividing line in the center of the road. The shoulders of the people on each end are pressed into the glass of their windows. Rwandan peasants, unaccustomed to the speed and the motion, look out of the car, down at their laps, and out again rapidly. Once one person starts vomiting, it is almost infectious… Pretty soon you have an entire roller-coaster scene, and not a plastic bag in sight because polyethylene bags were outlawed.
I came to Kibuye to visit my friend Lindsay’s former boss, Iris, the regional head of the UNHCR camp. I came also to visit the camp itself, having never seen a refugee resettlement situation. Iris had mentioned the fact that the peer education project in the camps could use some information specific to the refugee situation. As the modules I am working on address Gender-Based Violence (GBV) and Post-Traumatic-Stress-Disorder (PTSD) as well as other topics on HIV, we thought there might be room for collaboration.
The Kiziba camp is nestled onto one of the hilltops just under the highest mountain in the region, a 45-minute wash-board drive with some incredible views of the lake. When you round the corner to the road that continues to the camp, you can see the white tarpaulin cover from afar. The camp looks almost organic, like a fungal growth on a log. Even when you draw close it is hard to imagine that it is home to 18,000 people. You can see the schoolhouses first, long and rectangular, and the sprinkling of students dressed in strikingly sharp blue-colored uniforms wandering in and out for their morning break. Some of the students had wandered a little far on their recess; on the road to the camp we passed several youth dancing a little jig of freedom, the dance of “youth-cutting-class”. We pulled the car over to scold them in several languages for their lack of attendance.
I had in my mind the images of displaced populations in Rwanda as they are described by General Roméo Dallaire. I was imagining constant motion, deprivation, pup tents, and chaos. This camp is surprisingly methodical. The houses are as dense as I had imagined, made of sticks woven into walls and then covered with red mud for siding. When one UNHCR tarpaulin wears thin, another is added on top. Some houses looked like cakes, having been “iced over” so many times. There is perhaps 3 feet of space between houses, with a curved path sunk into the surrounding soil and little rivulets for water waste. But there are regular water pumps, little ambient trash, and a solid health center in the process of being expanded. As Iris pointed out, in some ways it the services here are better than the surrounding villages.
My initial lack of horror at viewing the camp was counteracted when I was told of its age. This camp had been around since 1996, a completely un-temporary timeframe. The residents of this camp came from Congo during the first of the Congolese wars, sparked by the migration of 2,000,000 Hutu refugees into the Congo after the genocide, and a Rwanda-supported-invasion-cum-civil-war to overthrow Mobutu. Congo became an unsafe region, and many Congolese Tutsis (a very nebulous and multinational category) “returned” to a land they had never known. The camp seems quaint and quiet at first, but no one invests the time and energy to construct well, because people’s homes are not their own, and no one knows when the camp will be closed. People have not put down roots, and it feels as though one could easily scrape the camp off the side of the hill, as if it were, in fact, a fungus on a log. The residents have had 11 years of World Food Program oil tins for windows, a tarpaulin for a roof, one room shared by many, no clothing, no public transport, no right to land, no right to collect firewood (that is brought in by a German partner to the UNHCR) and a thin mud wall in a cold and rainy climate. There is no income, little commerce (except for the trading of UN dried peas after 3-4 hours of walking each way), no higher education, and no resettlement as the Congo remains in perpetual flux. The UN does a good job keeping these people afloat, and yet they are exactly that: floating.
I will not expand on the Congo wars here. They are complex, and worthy of pages. I will recommend a newly-minted book on the subject: The Congo Wars: Conflict, Myth, and Reality by Thomas Turner. My brief comment on the subject is that four million have died in the Congo since 1996, making the wars the most deadly since WWII. Yet the Congo wars are poorly understood, and considered non-important compared with clearer-cut conflicts. Congo is also ignored because the majority of deaths are not brutal slaughters, but are due to displacement, starvation and disease. The situation in the Congo has been called “a war against women” as rape is actively used as a weapon. The rates of fistula (tearing between body cavities, usually the anus, vagina, and urethra) and of HIV caused by these rapes are horrifying. I hope that the modules I am working on might be appropriate for this refugee population, but at the same time, I feel foolish hoping that health education might result in mental relief to victims of PTSD or earlier care of new rape survivors. There is a feeling of incompetence inherent in picking up some small pieces of a conflict rather than preventing it.
In light of the craziness of the great-lakes region, it is hard to see past the damages to the successes. But I take them where I can get them:
Wita, a refugee, is making a small living my crafting little poupées (dolls). She carefully braids their plastic hair and sews on red-painted toenails to the dolls as they are represented pounding grain or carrying firewood.
Close to 20 men, women, and children were waiting for Voluntary Counseling and Testing for HIV when I arrived. One family had come to be tested as a whole. We were all engrossed in a rather graphic video on STIs, and a couple of the francophone women translated the banter: “I want to get tested for that one, too! God knows I don’t want my penis looking like that!”
When the car comes to take the AIDS patients to Kibuye hospital for treatment, people no longer fear that it will contaminate them. They no longer really notice it. Half the AIDS patients participate in the support group.
Outside the clinic there is a garden, expressly for baby food. The nutrition center houses slings and scales, stoves, cups and dishes. It is heartening to see the nascent peas and peanuts in the hard soil.
The wall of the primary school house has “Work+ Discipline= Success” written on it in mud. It’s a simple equation, and despite massive evidence to the contrary, some part of me believes in its power.
Silas, the head of their AIDS program, explained to me that one of the biggest problems with respect to sexual behavior change is the simple fact that there is nothing to do. Kids grow up in tiny crowded rooms, seeing their relatives have sex and then as teenagers they get bored. The camps distribute 1200 condoms every month. Silas suspects that many of them turn into soccer balls: blown up, tied, and wrapped with twine. Maybe, if they give the teenagers something to do, the condoms vicariously serve their purpose.
Maybe the breakdown of our “ideal” can show us where the “ideal” is found in reality.
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