Week 4 and 5 : april in Rwanda
Hello from Burundi

Like maybe an extra in a movie. Or being the friend to Jim Carey’s character in the Truman Show. Or the matrix. Maya like.

Where you are a witness and physically present but it does not carry the same weight as it does for them. Every reference point you have is a book or a movie, We wish to inform you that tomorrow you will be killed along with your families, Shindler’s list or Problem from Hell.

At least once or twice removed. But this is altogether different for them. It is reality. It feels a little off to be an observer to such raw collective mourning.

It is a weird feeling to be in Rwanda in April. Eerie. 15 years after the genocide.

April 6, 1994. and 100 days of violence began. Nearly a million massacred

I went to see the Partners in Health site in rural Rwanda last week. I didn’t remember what April meant to them. And when I arrived heading south of Kigali(Rwanda’s capital) there are large gatherings in community after community. Town hall style meetings every afternoon in the open air on red African dirt. Five hundred or six hundred people. We passed at least six of them on our 2 hour drive. Two weeks reserved for just this. It is all in the local language. I am sure it fosters some healing.

They are still uncovering mass graves. And families are still finding out slowly how their loved ones were murdered. A neighbor who knows and finally talks or an unexpected revelation from an acquaintance. And then maybe, hopefully closure.

But by a lot of accounts there is something manipulative about the two weeks of mourning. Orchestrated collective grief encouraged by the government. Paul Kagame, the Rwandan president was the rebel leader who led the insurgence to stop the genocide. He is now in power. And has disarmed everyone and disarmed dissent completely. Rwanda is getting more organized and he wants to turn it into the “Singapore of Africa”- an tech hub. Compared to Burundi it is first world. The relatively benevolent dictator.

He uses 4/6 like George W. used 9/11, to legitimize actions taken by government. But compared to Burundi, so much progress here. It is organized, clean, buzzing with the air conditioned mini malls of modernity.

I went to round with Partners in Health docs in Rwanda. Three hours for 45 patients to be seen by one doc. Cerebral malaria, miliary TB, full blown AIDS, peritoneal TB. Apparently, at their site there are 23 admissions a month for acute psychosis during these months. People breaking after so much suffering. Patients were two to a bed. And a young girl just started sobbing uncontrollably when we came to round on her. An orphan from the genocide, and April is not a good time of year.

I have never felt more like a witness and less like a doctor than here in Burundi. Watching but not acting. Checking under the hood, and saying “sorry, we don’t have the part here.” Not able to intervene.

Patric, our 8 year old with an acute abdomen. TB peritonitis with superinfection of bacteria. Pus when we put a needle in him. We rushed him to the regional government hospital. The doctors are still on strike but do emergencies. They operate and when we check on him a week later, he looks worse. Nobody is changing the dressings. No doctor followed him up.

A 3 year old with anemia. On exam. We got some labs on him. The lab said his hemoglobin was 9. It was actually much much lower. The labs are so often unreliable. He went into coma and died.

25 year old that was breathing a mile a minute. But her lungs sounded okay, she was coughing up blood. It took us two days to get a chest xry. An hour trip to the local hospital. No electricity, and their generator doesn’t have enough power to power the chest xry

Let the witness take a stand. Well... we’re working on it.

Good news for the week: Went to a wedding yesterday with Melino, our Burundian doc here! Borrowed his tie and shoes. Everybody was dressed so fly and there were hundreds of folks. Burundian after Burundian giving speeches. I sat but didn’t understand a word. Every time the crowd would break out into applause, I would lean over and ask Melino what the speaker had just said. More often than not, they ended their speech with a gift of a cow to the newly married couple. If they are really well off, two cows. If not, at least a goat. It apparently takes two cows to pay the dowery for a really good woman. And Melino is working on that.

Hope all is well!

Thanks for the updates, send more when you can

If anybody is working on any materials to send over, let me know. We could really use them. Lab equipment at your hospitals, medications.