Friday, May 25, 2012

Remembering Rwanda

"If you must remember, remember this...the Nazis did not kill 6 million Jews...nor the Interahamwe kill a million Tutsis,  they killed one and then another, then another...genocide is not a single act of murder, it's millions of acts of murder."

-Stephen Smith, Executive Director of Aegis Trust, 2004

During the days preceding April 10, 1994, women and children crowded into the Nyamata Catholic Church, 35km south of Kigali. Since April 6, when Rwandan President Habyarimana's airplane went crashing down, hateful messages filled the radio waves encouraging Hutus to find and kill their Tutsi and moderate Hutu neighbors.  Rwandans listened carefully as lists of names were read, knowing that minutes after hearing their own, roves of armed militias would come hunting for them.

Families of Tutsis crammed inside Nyamata Church just as they had before during periods of ethnic violence. So many arrived this time, however, that the small church's capacity was overloaded. Two thousand women and children hid within the sanctuary, while several thousand more gathered on the grounds surrounding.

On April 8, the Italian priests at Nyamata were evacuated along with thousands of other foreign diplomats and expatriates throughout the country. Those within the church knew this made them more vulnerable to the chaos, but they imagined that as in years past, the angry mobs would fear committing acts of violence under the gaze of the crucifix.

As the days passed, Hutu militias became emboldened and hate overcame fear of God.

On Sunday, April 10, gunfire was heard in the streets surrounding the church. Mothers clung to their babies and tried to calm their young children. The armed men of the Interahamwe militia approached, carrying guns, machetes, and clubs, sending those gathered outside the church’s main sanctuary running in all directions. Within the church, women attempted to stay the iron doors as rapid gunfire surrounded them, but their efforts were useless against the grenades and jackhammers of the genocidaires.

Within hours, over 10,000 women, children, and civilian men lay dead within the sanctuary and on the grounds surrounding. The church is particularly noted for the extent of torture and sexual violence that accompanied many of the killings. Men who were known to have HIV were chosen to rape women, and others experienced long and torturous deaths chosen specifically for the protracted pain they would cause their victims.

I visited Nyamata on a quiet Sunday morning. As I toured the grounds of the memorial site, church bells rang nearby.

The church has remained largely untouched since the massacre 18 years ago. Inside the main sanctuary, the Virgin Mary looks down from her perch above the altar. Below her gaze, the bloodstained clothes of thousands of the massacre’s victims rest in heaps upon the sanctuary's floor. Bullet holes riddle the tin roof, and only shards remain of the church's stained glass windows.

A massacre of the most appalling kind occurred here, and was replicated in churches, homes, streets and hillsides around the country during the 100 days of Rwandan genocide.

At the Kigali Memorial Center, built on the grounds of a mass grave housing the remains of an astonishing 250,000 individuals, the Aegis Trust has done an impressive job of remembering the lives of the genocide's 800,000-1.1 million victims. In the children's exhibit, large photographs of children murdered during the genocide--some smashed against walls, others hacked by machetes in their mothers' arms--are accompanied by placards telling each child's favorite game, food, and personality characteristics. In the main exhibit, video testimonies of survivors accompany the historical information, giving disturbing and often harrowing accounts from some of the few Tutsis who escaped the unprecedented violence.

Genocide is a type of murder which does not discriminate between innocents and combatants, making equal victims of babies and adults. It’s an act of incredible violence and inhumanity which makes people, even years later, uncomfortable to imagine. We shudder at hearing how ruthlessly an infant—unaware of ethnic distinctions, religion, or politics--can lose its life, yet few times in history have international leaders shown the bravery necessary to save the lives of those caught in the middle of genocidal plots.Visiting the sites of massacre and mass violence in Rwanda made clear the true definition of genocide as the act of thousands upon thousands of individual murders. No matter how much study I could have done before, no one is prepared to witness some of the worst acts committed by humanity.

The mass grave on the grounds of the Kigali Memorial Center.

The Nyamata Church which now serves as a memorial place for the 10,000 victims murdered within the sanctuary and on the grounds surrounding.

Monday, May 7, 2012

A Clinic in the Hills

Uganda’s nickname as “The Pearl of Africa” undoubtedly comes from its lush and hilly Southwest. Along its western border, the Rwenzori Mountains separate the Baamba and Bakonjo people and their cattle herding from the majority Banyarwanda of the Democratic Republic of Congo. Further to the south, the Virungas Mountains and their crystalline lakes are shared by Rwanda, DRC and Uganda.

I met my friend Alexi during a weekend trip to Jinja. Also from the coastal North County of San Diego, we talked about our shared friends, life at home, and the trials and triumphs of our work in Uganda. As a public health Peace Corps volunteer, Alexi had been assigned to work in a government health clinic in a small, remote village called Kazo in Southwest, Uganda. 

Home to the Banyankole people, Kazo is a beautiful and peaceful land, but one battling the vicious plague of HIV/AIDS.

I arrived at the health center having very little experience interacting with HIV/AIDS patients. On my first day there, Alexi showed me around the different wards and then introduced me to the clinic staff who welcomed me into the lab and walked me through the process of HIV testing, result delivery, and counseling.

One by one, patients came in and sat down to have their fingers pricked by a small needle. A drop of blood was placed upon a reactive strip of paper and within minutes, results would appear. 

In the span of an hour, I watched as six patients extended their hands and winced as the needle went into their finger. Of the six who came through on this Tuesday morning, half would find out they were infected with HIV.  Perhaps the most tragic of cases was a young girl barely 17 years old. As the clinicians read the positive results, they talked amongst themselves about the unfortunate case: with all of the outreach efforts to educate the community about the risks of unprotected sex, how did this girl become a victim so young?

As each patient returned to the lab for results, they were counseled. Two young men under the age of 21, both negative, were reminded of the risk of sex and warned that a negative test did not necessarily mean they did not have the virus in their bloodstream. Those who had positive results were sent to a trained counselor who explained their options for treatment and offered advice on how to continue living as fully as possible with the virus. 

During my second day at the clinic, I was taken to a room where tubes of HIV-positive blood were entered into a CD4+ analysis machine. The machine was in its first week of use at the clinic, a celebrated recent addition provided by the Ugandan Ministry of Health. I watched as the machine counted the CD4+ levels within each sample, essentially determining how able the body’s white blood cells are to respond to viruses and diseases. While a healthy person has a CD4+ count ranging from 800-1300, the lowest CD4 count of the day belonged to a 21 year old girl whose blood cell count was only 23, well below the threshold of 200 that makes one highly susceptible to opportunistic infections. Below 50 CD4+ cells per micro-liter of blood, the immune system becomes too weak to fight off normally harmless illnesses that can rapidly cause weight loss, blindness and death.

I was amazed by how the clinicians casually handled each result which affected me deeply. Minutes after recording a patient’s personal information and extracting their blood, they would be forced to play the role of God, informing a patient about their status and estimating how long they had to live.

After some time, one clinician suggested I receive an HIV test. At first, I refused, sure I was HIV-negative. But as I sat there in the lab and watched patient after patient enter, I started to think: in the past few months, I had cut my hand open with a knife in a kitchen shared with an HIV-positive woman; I had been pricked by a used, but supposedly sterilized needle when I was sick with malaria. I sat beside the lab worker and my heart raced as he prepared the needle. While I knew my chances of infection were much lower than those who had knowingly engaged in risky behaviors, I suddenly understood the uncertainty and anxiety present in a world where roughly 13% of the population has the deadly virus.

My results appeared quickly, and luckily were negative, but the experience of receiving the test in such a setting shook me to the core.

For the past 30 years, AIDS has ravaged Africa, debilitating families and prematurely ending lives. I realized early in my visit to the Kazo Clinic that the life of a medical health provider in Africa is incredibly noble, but ill-suited to my compassionate nature. For Alexi, an aspiring MSF doctor (Doctors Without Borders), dealing with such cases had become the norm. Over the past two years, he had witnessed countless patients come in with weakened, skeletal bodies, suffering from infections like pneumonia and tuberculosis, who came to the Kazo Clinic to die.