Life in Kigali

Thursday 8 Feb, 2007 – 18:58 – Kigali

At last, the first real update from Rwanda, not on genocide, not on a social justice conference, but simply on what I’ve experienced – life in Kigali. A long list of thoughts have accumulated that will someday hopefully make their way into a coherent and presentable posting, but I do not quite have time to do that now. All along I have wanted to share these with you, but more often than not at the end of the day I have been so frustrated by setbacks, annoyances, and the slow pace everything takes that I’ve been afraid to write, fearing immaturity and lack of patience would drone out meaningful observation.

After the first couple of days teaching Med. Lab. Tech. students, things kind of went downhill due to poor communication and lack of planning on the institute’s part. Essentially, when I finished giving my presentations, the course instructor ran out of immediate ideas for class. This upset me. On the streets people are dying because hospitals cannot treat patients efficiently enough to free beds for the other sick, and yet in the teaching institute, with all the educational resources available and potential for improvement, we sat idle.

Another professor asked for assistance (aka, wanted to know if I was interested in taking over) teaching a Physics of Medical Imaging course. I spent the next week reading textbooks, taking notes, and preparing lecture material – but I was miserable. It felt like I was spending all my time preparing for the next step but never taking it – and I just wanted to jump, to do something, to be useful somehow to someone. Once teaching began, some of that dissipated.

A large part of the frustration stemmed from not having a clinical outlet, as was my original intention. Whereas the world of academia is filled with artificial productivity, being in the hospital never seems like an absolute waste of time. After a series of disappointments, looking for clinical placements, I finally interviewed for and got a joint position in the Emergency and Laboratory departments in a large private hospital.

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<<>> Ok, look – this is getting really tiring, trying explain how everything has come together… and I understand that context is important, but if it is alright, I kind of just want to share stuff that I’ve been carrying with me, and hopefully it will make sense to you.

Yesterday morning was heavy. I like to get to school early when I teach. It was just before 7 and really quiet – the same sort of stillness you feel when you go outside after a heavy rain. No cars, no music, no wind, no people. And I was walking down the sidewalk heading one way, and this guy was in the middle of the street coming the other way. But he had no legs, so with sandals protecting his palms, he shuffled his body like an ape down that dirty road. He did not ask for money – he just walked like a man walks down the street, trying to make the best of the cards he was dealt. Images like this do not bother me as they used to; they still make me think, but I’m getting used to them and over my privileged-white-person guilt.

Okay, back up a couple of weeks so I can register some stuff before I was able to be at peace with all the third world’s craziness. I got into a half-empty matatu, heading home. Matatus do not leave until they are full. This meant I had to wait. People waiting on the inside of a Nissan van cannot go anywhere, which makes them great targets for beggars. A beggar approached the open door. He was blind – both eyes gouged out – holding the hand of a younger man who walks him around. One of the blind man’s eyelids was turned inside out for extra effect. When he held out his arms, I noticed he did not have much for fingers. In fact, only a right-hand stump and one left-hand finger remained. There were scars where fingers used to live. The guy next to me gave money, so I gave money too. Sometimes when I don’t know how to react I just watch what the local people do. After he collected, he was lead to the next matatu. But as soon as he left the next guy came forward, without missing a beat, as if he had been waiting in a line. This one was in a wheel chair and also had an assistant. Both legs cut off at the shin, both arms cut off at the forearm. Some days I’m never approached, some days these lines are endless.

Today my sister called when I was walking down the street. I was trying to listen, but got distracted. To my right, leaning against a tree, was a three-year old girl. Alone. Begging. What do you do about that?

I don’t give money to beggars anymore. I used to, sort of. Well, not really – but I did on occasion. Giving money does not so much help their problem as it does alleviate my guilt. I also just don’t like to give money – not so much because I’m selfish (although I am), but because I don’t know how they are going to spend it. When I was drinking tea this morning, a man approached me from the street, sniffing a bottle of glue in his left hand and holding out an open palm with his right.

I used to have a long list of criteria that beggars had to meet in order for me to help them, but I got rid of most of them. For the most part I just look at people’s feet – if they have shoes they are okay. A young girl, maybe 9, was shoeless and begging the other night on my way home from the hospital, so I took her to a restaurant and ordered chicken – protein… something that is actually good for her (as opposed to fried potatoes, boiled flour-water, mashed plantains, and rice – a combination of typical meals, all options lacking nutrition). I think it is better to buy food than give money.

An email to my sister from a while back:

Hey Lizz-

Funny I should describe it as a wave of happiness, with the implication being that happiness is not the norm. My feelings here are similar to what I found your feelings to be in Syria. Parts I love, others are absolutely draining. In particular, hearing people shout "mzungu!" (meaning white man) is especially tiring. The term is not usually meant with any hostility or inkling of racism, and yet it's exactly that – seeing someone for their color and not their person. I say 'not usually' because although they claim it's an innocent term, as the recipient it's often received with the implication that white people are rich and ignorant, a constant reminder that we are outsiders… and that the boundary will always exist. It's used like this: "Mzungu!" pointing and giggling, "Hehehe… what is that white man doing, he must be lost! Hahaha!" Or what feels worse is when people shout, "Mzungu" to get my attention, then knowing I don't speak their language, crack a mzungu joke for all their friends to laugh at. It's a term used without realizing or attempting to understand why people like me are here in the first place. Not that people's appreciation should be the determining factor of whether or not we choose certain paths of service, but void of appreciation the paths are much more difficult to travel, and painful in their own right.

Frequently people pose as friends, establishing a relationship, and then two minutes into the conversation comes the sad story and hit up for money. But they don't need the money – they're lazy and want to rip off the gullible. These are Maria's thoughts, not mine. She points to situations like this that she's been in as a person with money. Because she drives a car, people think she has money to dispense. It's a fair assumption, but if their need was as dire as its made out to be, then the pitch would be posed to everyone who's willing to listen – not just the black driving a car or the white wearing a tie.

But then just when I feel exhausted, a barefooted child runs to catch up with me and says in a soft, voice of awe "mzunguuuuu". And he clasps my hand with one of his, and with the other runs his curious fingers through the hair on my arm – like he's come across an odd machine that he really wants to study and know. And I pick him up, and we spin until we're dizzy – then put him down when he is on the verge of wetting himself (a 'short call', as it's named here). Then we laugh and walk and hold hands, and move down the dirt road together. These moments make all the others worthwhile.
With love,
Benjamin

This sort of teasing I described happens all the time. It's ignorant racism; the people mean no harm. But it is frustrating. What's equally frustrating is this realization - that to look at a beggar and not give is worse than to flat out, cold-shoulder, ignore their existence. When you look and try to treat them with dignity, you light hope which, when let down, hurts both of you.

Alright, my work. What do I do? Well, like I’ve said I’m teaching Physics of Medical Imaging (x-ray, CT, ultra sound, MRI, etc). There are only 10 students in the class, which is much more manageable than the 45 in the first course. The schedule is ever-changing, but it does not bother me anymore – I just roll with it. Figured out that getting upset is a waste of time – and once I got that down, everything seemed to go much better. Last week I taught on Wednesday. This week I teach Wednesday and Friday. Next week I teach Tuesday, Wednesday and Friday. Some days for only two hours, some days four hours straight. What am I saying? Just that it’s confusing, but I hope the students are able to take away useful education.

Work work. I’m at the largest private hospital in the country, in the departments of emergency and laboratory, and in the operating room on occasion. Pretty much I fill in gaps – triage patients, take vital signs, throw on ECGs, and take blood out of arms. It’s a hospital in a third world country, which I realize sounds exciting, but the work is actually pretty boring and uneventful. The big reason for this is that it is private. That means it’s fancier, cleaner, and for rich people. And frequently rich people go to the hospital for small things – headaches and such. Most of the adults either have high blood pressure or malaria, and most of the children have bronchospasms or URTIs (upper respiratory tract infections… crap in their throat/lungs that makes breathing difficult). Other than the malaria, it’s really not all that different from a hospital in the US.

But what about the poor people? They go to the large public hospital. When I asked about this place, the description I got was: multiple patients per bed, unrelated to each other, different diseases. Men sitting crouched in a corner, IVs coming out their arms, the tubes leading to a blood transfusion bags above their heads.

I wanted to see these things for myself, but did not know how it would be possible. A few weeks ago when I applied for an internship I got the old bureaucratic run-around. A bunch of stupid people wanting to display their power, making life difficult when all I wanted to do was help. So how did I verify what I was told? Let me break here to tell you a story from Nairobi (it will make sense in good time).

I was sitting next to a Maasai (what you picture when you think of tribal people from Kenya – spears, beads, scars, et cetera) and struck up a conversation. At one point I asked him how often he really wears his traditional clothing. “This, my friend,” he said pointing to his outfit, “is a pass that gets me places I would not otherwise be able to go. When people see me like this they’re taken back and wowed. And they also think I must be uneducated, so they don’t even bother to tell me I cannot go through some closed doors. When I wear this, I can do anything”.

From him I’ve learned I can do the same, except at the opposite end of the spectrum. My white skin and fancy clothes are passes that get me anywhere. So I put on some polished leather shoes, carefully made my tie, and set off to the public hospital. Everything I heard was true. A man in an automobile accident, moaning, gaping wound. A fly crawling in his bloody leg. Patients curled up every which way throughout the hallways. They are not supposed to be there, but you cannot move them because they’ll just come back. They contort their bodies to squeeze into the smallest of spaces, hoping to be seen next, and then somehow fall asleep like that. Time is elastic in Africa – people don’t mind waiting, don’t really have schedules, and just kind of do their thing. And so it is in the hospital – people just waiting to be seen.

A TB/AIDS ward – packed, much different from my experiences in the northern-Kenyan bush clinic. Eighteen inches between beds – and there are a lot of beds in a small room.

A story from a friend of mine, from his residency years at the public hospital before he became a physician in the private hospital: A co-worker, responsible for stocking the hospital, one day noticed they were running out of Oxygen, but for some reason did not think to get more. Three days later, in the middle of the night, the oxygen ran out. There were eight children on oxygen – five of them died. My friend was distressed re-telling the event. Parents screaming, crying, “why didn’t you tell us? We could have sold our houses, our everything, and gone to the private hospital”. Stuff like that happens in the public facility. It’s the place you envision when you think of African hospitals - understaffed, underfinanced, overburdened. It’s a mess, an embarrassment and a shame.

Back to the clothes. These fancy clothes did not originally cross the Atlantic with me, but once landing in Rwanda and getting to the Kigali Health Institute, it was apparent that teachers are expected to dress in such fashion. At first I hated wearing fancy clothes in an impoverished because I hated being ‘that white guy’. But then my little Rwandese brother told me sometimes kids go home and brag to friends and family on days they shake hands with a white – as if it were something special, like shaking hands with a President. Ever since then I have not minded dressing nice, because I shake hands with all the street kids – in some small part breaking down the misconception that rich whites are above them. Shaking hands with all of them makes it less special and more normal.

One of my favorite parts of life here is walking. Sometimes when I’m on the streets I catch people looking at me, wondering how much I have really invested in their country – wondering whether or not I speak their language. I don’t, obviously, but I have learned a handful of useful phrases, and can exchange greetings with the best of them. So I wait, timing it just right, then say as we pass each other “beetay bjaway?” (how are you?). Oh they laugh so much with delight, and I smile, but most importantly by the time they settle down to ask a follow up question, I am far enough away to effectively dodge such a trap.

I’ve got so much more, but 1) I’m hungry and tired, and 2) If you’ve made it this far, you’re probably also hungry and tired.

I’ll try to write more often, but so many nights I come home exhausted and it’s difficult to move, let alone think. Thanks for caring, though. I really appreciate it. Many days I feel sustained by the thoughts and prayers of my friends back home.

Sincerely and with love,
Benjamin John Fullerton Huntley