Day 12: Save the Worst (or Best) for Last or the Long and Winding Road (from the Beatles)
This was the one day we felt we made a real difference. Maybe I am speaking for myself. Several of our group left Sunday and the rest of us made an all-day trek through the rural regions of Rwanda’s south end. The highway was a VERY high quality highway. I was told by Dr. Aflodis that the highway was relatively recently made (within the last few months). He said it was a joint effort between Rwanda and Germany (he says Germans make the best roads).
I have come to call Rwanda by a few different phrases . . . The land of paradoxes . . . Land of a thousand hills and only six potholes . . . Rwandans expect only the best. They want the best quality for everything. They dress neat and stay clean – even when wearing white! Those who do not care to stay clean are looked down upon. Rwandans like to research who is best at a thing before they import it. Electronics. Roads. Communications.
Paradoxes of paradoxes . . . Even in the remotest of areas, our cell phones had perfect reception. Even in the areas where there is no running water or electricity, there is cell phone coverage. President Kagame wants to fast-track the country into a mighty economic force. It looks like he is on course.
I am becoming more comfortable in stumbling through the KinyaRwandan language. People are very willing to help me. It is an incredibly difficult language. Several Rwandans have admitted to me that they also think it is difficult, even for them.
Anyway, back to the story of Day 12. We went to one of the remotest health centers on the far south end of the country, near the border to Burundi. The highway there was no problem. It was the turn-off that was a great challenge. The dirt road was ruts and bumps galore. Several miles’ worth. We thought we would all have a concussion by the time we arrived there from bumping our heads against the vehicle.
Half way from the highway to the health center, we drove by a refugee camp (though Rwanda does not call it a refugee camp). Back in the late fifties and early sixties, during a time of great strife in Rwnada, many people emigrated to neighboring countries: Uganda, Kenya, Congo, Burundi, and Tanzania. Recently, Tanzania has been blaming their problems on Rwandan immigrants. It has been about 50 years since the mass immigration and in that time, many Rwandans have been fully integrated into Tanzanian society. However, Tanzania has nationalized Rwandan immigrants’ possessions, taken all their assets and kicked them out of the country. Much like Germany and Jews in the 1930s. Many of the Tanzanian Rwandans have never been to Rwanda. Suddenly, Rwanda has had a large influx of impoverished (formerly well-to-do) Tanzanian Rwandans. Rwanda has built these temporary communities, rows and rows of huts. They are then building better homes next to the huts made of clay bricks. They also build schools in these communities. We drove by one school during recess time. They were playing soccer with a ball made out of scrap materials (tape, rubber bands, paper, etc.). Once we stopped, they came crowding around the vehicle.
We came to the health center at the end of the dirt road. This picture is looking away from the health center back up the road toward the unfinished mosque (there is a finished one in the middle of the refugee camp).
We had brought lots of medical supplies with us and shared a portion with the first health center. The health center seemed to be like an oasis in the middle of nothing. They had some power (not enough) that was generated through solar cells. Very primitive accommodations by American standards. Notice all the energy storage batteries in this photo.
I took few pictures because I just did not like the feeling of being a typical American tourist who takes pictures of people as if they were on display. I ocassionally notice the poor being offended, sometimes openly. Taking a picture is for our own pleasure and is at their expense – at least from their perspective. The poorest often expect us to pay for us to take their pictures. The pictures I took were done either very discretely or only after I had established some bond with them.
I bonded with this family and took a few shots of them, showing them the digital image on my camera. Quite entertaining for them.
As we were about to leave, our neonatologist noticed an infant that had a peculiar look. Long story short, she informed the health center staff that the child needed immediate care or the child would die very soon. Interestingly, the mother had come to the health center because her three-year-old had a fever. The mother admitted that the infant could not keep any breast milk down. The child was clearly malnourished.
We drove to the next health center, which was less remote, but was also more primitive. I found my niche when I practice a little KinyaRwandan in the maternity room. There were six pregnant women in there. One, who I believe was actually in recovery from birthing, had a very small infant and a baby in bed with her. I have no idea if they were both her kids (she acted like they were) because the math just could not compute. The baby seemed to be less than nine months and the infant appeared to be newborn. I held the little girl for about a half hour, then I was summoned into the next room, the birthing room.
The head nurse (remember that health centers have no doctors by definition), explained that some pregnant women show up in the middle of the birthing process, aka the head has already crowned and babies are “stuck” if you will. It is more than the health center is able to deal with, so they call the ambulance, which may take hours or days before the woman reaches an actual hospital. The result is high infant mortality.
Our team showed them some simple techniques to help the women deliver babies who are “stuck.” Because all our women were wearing skirts or dresses, they summoned me out of the labor/recovery room to demonstrate the techniques. They put me on a birthing table, shoved my legs back, pushed on my pubis (ouch!), made me turn over and pretend to deliver a baby while on my hands and knees. It was clearly educational and entertaining all at the same time. I think the educational demonstration was as much appreciated as the medical supplies.
As we were about to leave, Dr. Aflodis told me he was getting tired and asked me to drive. Now that was entertaining! “Mzungu umushaferi!” I said. “Me, the white guy, is driving!” They all laughed. The steering wheel was on the right side of the vehicle. All the Rwandans ran after the vehicle yelling and yelling. Dr. Aflodis said that he believed no Mzungu had ever driven that road. Thus, no Rwandan there had ever seen a Mzungu drive a vehicle. I figured that at least one white U.N. driver had been there, but he told me that white people always pay to have a Rwandan drive. Anyway, in every town we passed through, Rwandan children would run after us yelling. Adults stopped what they were doing and gawked at the Mzungu driving. I just smiled and waved.
Half our group decided to go on to a third health center and the rest of us went back to the hotel. It turns out the last health center was actually called a healt post. It did not meet the Rwandan standard of a true health center. Imagine, if the health centers provide about as much care as we are able to do at home in the USA, how much less a health post is able to do. Two beds, a small desk, a drawer with some meds, two nurses on staff who rotate shifts. The team actually had to teach them how to use a blood pressure cuff.
TIA: This is Africa. We went to dinner at 7, but were served food about 9 or 9:30. We had been out in the “bush” all day, no lunch, no water (except those of us who had brought some). We were tired and cranky. So many began the transition back to the states. “I cannot wait to go in a restaurant and actually get served in a timely manner,” some were saying.
Silly Mzungus, TIA. Slow, patient, no worries, just acceptance that life is what it is. No hurry. The problems will still be there to tackle tomorrow. And when you solve today’s problems, tomorrow will hand you more. Besides, what is a little problem of waiting for your food when just outside the restaurant doors are thousands of people who have not eaten since yesterday? A few who have not eaten in over 24 hours. Most, even those with jobs, are used to eating less than three meals per day.
Our party leaves before me, pay me their fair share. I wait for the check. I was told not to tip them. The bill comes to $130USD. About $10 per person. I tipped the staff anyway, but not much. It came to about a 3% tip. That’s 30 cents per person for a meal that cost $10 dollars per person. I am not sure what to think of that. Tipping is not necessarily customary in Rwanda, but they seem to know Americans are accustomed to tipping.
It is time to pack, get ready to leave. Sadness and anticipation mixed together. My legs will leave and take my unwilling body with it. My heart is torn: I miss my dear family, friends, and colleagues, but now I will miss Rwanda. No matter where I go, from this day forward, I will always be missing someone.
With great love to you all,