The final month...

“I don’t think you know what this is like… to have your love pinned to my life… like something I can’t hold onto and something I can not leave behind. Maybe you’re just not afraid of anything in this whole world… maybe you have never held nothing in your hands.. Heaven help me .. when I think I’m not enough for this world.. Heaven help me.. when I think I am…"

That’s a song quote in honor of my friend Brian Webb (an amazing singer-songwriter) who is playing in a few hours at Club Passim way back over there in what feels like a completely other life that a completely different person lived in Boston (although if I were back I’d be there at a front table in a flash!) . It’s from a yet unrecorded song “Strange way to Grieve” and happens to encapsulate all the swirling emotions I’m having as I enter my last month here in Rwanda –(my last month at least for this stretch- I can’t imagine *not* returning). He’s probably sold out but if you’re fortunate enough to get in (10PM Friday November 18) you won’t be disappointed.. although hmm.. as I’m recalculating the time difference I realize he might be actually playing now (the daylight savings time always confuses me, there is no springing forward or falling back in the tropics…).

I am awake at this hour (3AM) here in Kigali – for some reason an insomniac the past few weeks, desperately tired and more than a little homesick as the holidays approach. The health center and hospital at the camp is operating so smoothly now – I’ve been able to concentrate my efforts more on administration/fund raising and budget planning – things I have to say I don’t enjoy nearly as much – but I’ve been purposefully withdrawing myself from the day to day operations of the health center and hospital… slowly but steadily .. It’s perhaps like having a child and learning to let go – it hurts a little to not be there every minute helping and advising but I know that it’s time for them to fly on their own… and more importantly they are *able* to. I am so proud of my nurses and staff – when I follow up (probably more often than I should) everything is in order, admission notes, vital signs, medication records… Our family planning / prenatal clinic /minor surg clinics are running smoothly – we have weekly HIV testing where we regularly have far more than the 20 patients that can be tested each week (I am in the midst of hammering out an agreement for antiretroviral drug provision) – the monthly vaccination campaigns run like clockwork… our laboratory is fully functional (I am also in the midst of some wheeling and dealing to obtain the final two big pieces of equipment needed – a kerosene powered refrigerator and an autoclave), Counseling and physiotherapy has started.. . Ben (the medical coordinator) and my nurses have such an ownership and pride in their work as well as such dedication – the refugee and national staff are working together remarkably well, we have trained 5 new refugees in basic nursing skills who have become valuable members of the team, and I realize happily and a little sadly that I am rapidly becoming superfluous… which is the whole point after all “local capacity building” as the country director Barry puts it. I still see a fair share of patients – but the consultations are more perfunctory – more often than not I am just signing off on a plan of management that I could have written myself… I seem to have worked myself out of a job!

Our new lab with Leonia - our new lab tech!

Meanwhile there have been this string of visitors from various NGO’s “aid-gamers” as one book I read cynically put it.. as the year ends all agencies seem desperate to make their token visits so we can be some footnote in their annual report… so I’m perhaps sounding a little cynical myself… It’s just when you see the problems every day – when refugees come to you every day – when their children are hungry and they can’t provide enough food for them, when their children don’t have any clothes or shoes to wear, when their children are suffering every month with malaria because there are no mosquito nets… when their children are *still* not in school after 8 months because of some bureaucratic quagmire between UNHCR and the Rwandese Ministry of Education – and I’m seeing this and hearing this every day… when our old battered vehicles are constantly breaking down and we have to push them to get them started… in the midst of these daily struggles some immaculate white land cruiser pulls into the camp (most often unannounced) with some equally immaculately dressed “aid-gamer” from some cleverly titled NGO with a cute logo on the door of the SUV… and we are expected drop everything we are doing to greet them and show them around the camp and tell them about our programs… (almost like it’s a tourist site and these children and families are on display) … it’s hard to not get a little cynical.

Don’t get me wrong – some agencies have been wonderful. UNICEF in particular has promised real *tangible* help in the form of 2,000 blankets, nutritional supplement biscuits, delivery kits, educational kits… Refugees International has pledged $5,000 for malaria prevention, and USAID through PEPFAR has given a large amount of funding so we can start out own HIV testing in the camp…meanwhile EGPAF is funding the testing and treatment of our HIV patients currently… all these things are truly wonderful and make worlds of difference. It’s some of the other organizations that can be so frustrating (they will remain nameless for now).

One in particular – an agency dedicated to the welfare of children – came a month ago, and we detailed the needs, the very *basic* needs of the children in our camp (supplementary food, clothing, medicines etc..) they looked around and said with a straight face that they couldn’t really help us with those basic needs because “our mandate is really just advocacy for children’s rights” … What the heck does that even mean? What are the rights of children if not education, food, clothing and healthcare???? They came back again last week – having hired an “expert” to come work in the camp for the next few months giving lectures and “mobilizing the population” about the rights of children.

So that particular day I’m very tired from having been in a hot tent all morning taking care of yet another dozen children all having convulsions from temperatures over 104 from malaria – and I’m listening to this very nice French-Canadian country director of this organization introducing me to this woman who I’m sure is lovely and has great intentions but I can’t help getting a little angry. I say in my much improved French – and probably not very politely that I have never seen an “abused” child in this camp. Not in the western sense of the word. It’s not as if these parents don’t love their children or don’t know what their children need. The fact of the matter is that they do *not* have the resources… *we* do not have the resources to provide the things these children need. And listening to some self-professed expert on the rights of children talk all day and night is not going to give these parents the clothes, food, schools or medicine that they already know their children need. There are no sweatshops hiding in the bushes of this refugee camp – I can feel myself getting angry again just writing about it. So the inevitable result of this “mobilization of the population on children’s rights” is going to be parents being told that their children deserve to go to school, and deserve adequate food and adequate clothing (as if they didn’t know this already – I feel it’s demeaning and condescending) and then this expert will leave without providing any real assistance and the workers who were there before this expert and will be there after this expert will be left with an even more dissatisfied population and will be just as unable to provide for them… I feel like screaming “use this woman’s salary to buy some clothes for the kids.. or send her to lobby the Rwandese Ministry of Education for school for these kids… or come even to the health center and sponge down a baby with a 104 degree temperature.” Do *something* but don’t just talk… sigh. But this is the reality of aid work – or maybe just another reality of life – there will be “talkers” and there will be “doers” and I just happen to have come across too many “talkers” for my liking these past two weeks.

Speaking of “doers” thanks to Dr. Marjie Curran (pediatrician extraordinaire) from MGH for managing to send a case of Elimite, infants Tylenol and Motrin, something that will alleviate the suffering of these children far more than 2 months of lectures to their parents (OK, I realize I’m sounding bitter…I think it comes from being over tired). On to happier topics.

Soap making 101

To get a head start on the Income Generating Projects that Louise will be returning in January – April to head up – Theodore has begun soap-making training for the refugees. It’s an incredibly rewarding experience to teach a new skill and especially for this population where on this rocky mountainside agricultural possibilities are quite limited – these small IGPs are not only adding an influx of money but also industry and self respect into a demoralized population. Louise has been busy back home in Minnesota fundraising and will hit the ground running with small business loans. And it makes me realize more and more that this is *really* the biggest and most rewarding part of the job – giving a population skills that they will always have and be able to use – it’s true in the health sector as well as the IGP world…

The Soap Coming out of the Mold

Theo demonstrating the cutting technique

The happy group and the finished product

Newest and Oldest patients!

I think I mentioned in one of my last posts that we have started deliveries with the hiring of a midwife – and despite the fact that it still scares me a little (not having any resuscitation equipment for the babies) we have done half a dozen successful deliveries. We also have had a few more transfers from Congo - including this 100 year old woman (can you imagine being a refugee at 100 yrs old) who despite everything is so sharp and has a great if resigned attitude on her life here.

Ben with our newest mother & baby

After 100 years of living - now a Refugee

Thank you to everyone again for all of your support and well wishes. I can not express how much they mean to me - especially down the homestretch here when I am getting so tired and homesick and more than a little lonely at times. I'm hoping to see the mountain gorillas and a few other "touristy" sites before I go. I have found a flat in London - right in the center a few blooks from the London School of Tropical Medicine so thanks for those who have helped in the housing search as well - I do expect visitors in London! (and thanks to Danica for being so wonderful and flexible in facilitating the funding - I'll be sending more receipts your way!!) Happy Thanksgiving to everyone and God Bless,

I'll end with another quote which pretty much sums up life here... it's from Nigerian Booker Prize winning author Ben Okri's Book The Famished Road

"It was dark in the forest till we got to a clearing. In the middle of the clearing a solitary wooden pole had been stuck into the earth. The pole had burst into flower. Little buds had grown out along its length and some of the buds had opened into the beginnings of branches. Dad said: 'This is what you must be like. Grow wherever life puts you down.' "

Love,
Ann