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.
Posted by Caitlin Lee Cohen at 04:06 PM | Comments (0) | TrackBack
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.
Posted by Caitlin Lee Cohen at 04:02 PM | Comments (0) | TrackBack
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.
Posted by Caitlin Lee Cohen at 03:56 PM | Comments (0) | TrackBack
