Second Suns

by David Oliver Relin

  After the meal, politicians came to make speeches in front of the local press, and medical administrators presented each of us with enormous framed certificates commemorating our visit. Ruit kept his remarks customarily brief, praising the efforts of his team and the strides the local staff had made since he’d first come to Sikkim. Dr. Dhakal, the ophthalmic consultant for the Sikkim State Health Service, didn’t hold back his praise. During the fifteen years since Ruit had started operating in his isolated corner of the Himalaya, Dhakal had come to see his friend Sanduk as something more than a mentor. He seemed to view Ruit—as the Dalai Lama did—more like a medical Buddha. Dhakal spoke emotionally and at length about the isolation and poverty Sikkim had once faced and how dramatically Ruit’s frequent visits had upgraded not only his own surgical skills but the local population’s quality of life. “My excellent friend Dr. Sanduk Ruit,” he concluded, “is a true illuminary.”

  Technically, the word may not have existed in English. But I could think of no better way to describe what the boy from Olangchungola had become.

  This Is Rwanda

  People can be made bad, and they can be taught to be good.

  —President Paul Kagame

  John Nkurikiye met us at the airport, wearing the green camouflage combat fatigues of the Rwandan Defence Force. I hadn’t realized that he was still a soldier, but we hadn’t talked about much beyond his medical aspirations when I’d met him at the Moran. In Utah, he’d seemed bright, witty, and a bit meek for a surgeon. He’d been out of his element, I realized, watching Major Nkurikiye stride across Kigali International in his combat boots, his bright eyes fastened on the Styrofoam box plastered with stickers that Geoff Tabin carried casually under his arm.

  “How many were you able to bring?” he asked.

  “Eighteen fresh and two preserved.”

  “Eighteen fresh!” Nkurikiye said. “Good, good. We have a lot of customers who’d like to see.”

  On our drive into the capital we passed several billboards that featured a photo of Nkurikiye, in a white lab coat and a green military beret, squinting to examine a young woman through a slit lamp. The billboards commemorated Army Week, a period of public service during which Rwanda’s armed forces put aside their defense duties and worked on humanitarian projects across the country. Alongside Nkurikiye’s image, the billboards showed soldiers digging trenches for clean-water projects and distributing sacks of high-yield seeds to farmers from the rear hatch of a military transport helicopter.

  Looking out the windows, as we entered the city with Nkurikiye at the wheel of his worn SUV, I was struck by the recently built glass-and-steel structures topping the many hills that made up central Kigali, and the late-model vehicles gliding through a series of traffic circles planted with flowering shrubs. Kigali had a coffee shop in a mall modeled after Starbucks that offered complimentary Wi-Fi. Fifteen years after enduring the worst rampage of mass murder in modern history, Kigali didn’t look like the survivor of anything; it seemed like a model of affluence and intelligent development. But scars were still visible, if you knew where to look.

  Nkurikiye pointed to the bullet holes that pocked the façades of the national parliament building and the Mille Collines hotel, the infamous setting of the film Hotel Rwanda, as he drove us toward our lodgings, a newly built boutique hotel that featured an expansive view of Kigali’s hills from its terrace café and a pool with a swim-up bar.

  While we were waiting to check in, I browsed a rack of pamphlets. Next to brochures touting trips to visit Rwanda’s endangered mountain gorillas I saw a pamphlet advertising the city’s top tourist attraction, the Kigali Genocide Memorial Centre. It noted that the complex featured “artfully arranged exhibits explaining Rwanda’s recent history, mass graves containing the remains of more than two hundred and fifty thousand victims, and a fully equipped gift shop.” After I put it back, I noticed deep scars in the scalp, forehead, and neck of the maid who was polishing the marble floors of the reception area.

  Tabin was clearly growing as a leader in his own right, capable of assembling teams of technicians and supporters in Africa, similar to the way Ruit organized them across the eastern Himalaya. Following the path Alan Crandall had paved, the HCP was building an eye hospital and ophthalmic training center in Ghana, and with the HCP’s help, Dr. Meshesha was turning Quiha Zonal Hospital into one of Africa’s best eye-care facilities. Tabin had even greater hopes for Major Nkurikiye. I recalled the phrase he’d used the first morning we’d sped down I-80 in his truck, when I’d eavesdropped on his daily call with Ruit: “I think John could be the person to really anchor eye care in Africa,” he’d said. And I remembered the moment over weak coffee in the Moran’s café when Nkurikiye had told me he hoped, one day, to be the “Ruit of Rwanda.” For Tabin, more was riding on this trip to Rwanda than simply repairing patients’ eyes. As Ruit had done to him, he planned to put Nkurikiye to the test.

  Tabin seemed elated that the logistics he’d organized hadn’t hit any road bumps and that we’d all arrived with our gear intact. At the hotel’s reception desk, holding the box of corneas, he tapped his feet with anticipation. Ace Kvale and his friend Michael Brown, the filmmaker who’d shot Light of the Himalaya, had brought still and movie cameras along to document Tabin’s work for future HCP fund-raisers. Bal Sunder Chansi, the logistical specialist who’d directed our effort in Quiha hospital, and a scrub nurse named Soba Sharma had come from Tilganga to manage a cataract camp we planned to conduct in the countryside. And Tabin had invited Laura Cohen and Chaz Langelier, two American medical students who would help Chansi screen five thousand potential patients in the U.N. Millennium Village of Mayange and the surrounding communities.

  They were joined by Tabin’s twenty-four-year-old daughter, Emilia, who had just been accepted by Stanford’s medical school. She was here to watch her father work and get experience in the field before classes started in the fall.

  Check-in took nearly an hour, since we arrived at the same time as another large group of Americans. Andrew Palau, the fresh young face of the Oregon-based Palau ministry, which his father had founded, and his wife, Wendy, had come to Kigali with an armada of doctors, nurses, sound and light technicians, and a pack of teenage skateboarders with bright pink and platinum-blond faux-’hawk hairdos. They had arranged to hold a combination skateboarding exhibition, free health clinic, and evangelical prayer meeting in the national soccer stadium.

  Missionaries, medical groups, agricultural experts, and, now, even skateboarders for Jesus. A varied influx of individuals aiming to make the world a better place, in the ways they considered most effective, had invaded Rwanda since the genocide. I believed it was an invasion motivated by the guilt of a world that had failed to step in when Rwandans had needed them most, to put a stop to the slaughter. Despite their initial unwillingness to become involved, it was hard to fault the fact that many of the international community’s charities had since opened offices in Kigali, investors had arrived en masse, and the city that was inarguably the most dangerous place in the world in 1994 had, by the time we arrived, become one of the safest and most orderly in all of Africa.

  Dr. Paul Farmer, the international public health advocate most famous for his work in Haiti, and the subject of Tracy Kidder’s powerful book Mountains Beyond Mountains, had opened a branch of his Partners in Health NGO in Kigali. It was Farmer who’d introduced Nkurikiye to Tabin, calling him, according to Tabin, “one of the most dedicated doctors I know of in Africa.” And it was on our first day at Kigali’s King Faisal Hospital, where Nkurikiye directs the Department of Ophthalmology, that I saw that dedication in action.

  In his operating room, even though he was wearing scrubs rather than fatigues, there was still something military about Dr. Nkurikiye’s bearing. He ordered his staff into their positions in a low voice, and they leapt to their places, eager to please him. I tried to recall who his manner reminded me of, and when he tied his mask on and bent over his first case, I realized it was Ruit
.

  Tabin operated at another table. He was only ten feet away, but with the nurses, technicians, photographers, and filmmakers, plus a local television crew who’d come to report on the surgery, the room was too crowded for the doctors to talk to each other while they worked. “This is really a mixed blessing,” Tabin said. “I put in a request for all available corneas just before I left. I expected to get four or five. But eighteen! I’ve never had so many at once, and we can’t waste them. I’d planned to sit with John while he did the cases, but now there’s no time.”

  When I first met him in Utah, Nkurikiye had already watched Tabin perform corneal transplants for three months at the Moran, but American medical practices forbade him from operating. At Tilganga, he’d done a handful of his own surgeries but had mostly watched Reeta work. Now he had a young woman on his table who’d traveled to South Africa for a corneal transplant that had since failed. He had a chance to better the work of the most accomplished surgeons on the African continent, and he was delighted to perform such an advanced procedure in his own operating room.

  At first, watching the two doctors, you’d think Tabin was the novice. But that was due to the crisis developing on his table. A sixteen-year-old girl named Claudine Cyuzuzo had been prepped for surgery with an injection of anesthesia, and Tabin had begun to operate. After he had cut away half of the corneal tissue he needed to remove, Cyuzuzo began writhing and wailing with pain. “I need help!” Tabin shouted. “I need everyone in the room focusing on this case only! Can we convert to general? Can we get her a better local block? Her eye is open and she could lose her lens. We need to do something! Right … this … second.”

  Emilia was frozen by her father’s side, her blue eyes wide as the situation threatened to spiral out of control. A Rwandan anesthesiologist rushed across the room with a needle and plunged it into the side of the girl’s eye socket. Within minutes, her thrashing calmed, her wailing quieted, and Tabin went back to work.

  “Well, that was quite exciting for a few seconds,” Tabin said, “but now we’re out of danger.” He removed the rest of the opaque center of the cornea and asked his daughter to bring him one of the donated tissues. Emilia brought her father a cylindrical plastic container and struggled to unscrew the top. The cornea, about the size of a contact lens but with ragged edges, floated in pink preservative. After Tabin removed it delicately with a forceps, I looked at the container’s label. It said that the donor was a fifty-two-year-old female from Birmingham, Alabama, who had died three days earlier of lung cancer.

  For me, no mission of the space shuttle or probe beaming back photos from the cold edge of the solar system could overshadow this incredible, and incredibly rapid, transfer of resources—the journey this flap of tissue had made from the American South to east-central Africa. Because of recent advances in medicine and the generosity of an anonymous American woman facing her own premature mortality, a blind sixteen-year-old girl in Kigali would have a chance to compile a lifetime of visual memories.

  Tabin called me over to examine the graft as he tied his last suture. I looked through the eyepiece and saw the neat circle of black stitches, magnified so it looked like a helicopter landing pad. “It looks clean and tight,” I said. “Not that I’d really know.”

  “It’s perfect,” Tabin said. “I really, really like my wound edges. This young lady’s going to see just fantastic!”

  Nkurikiye had successfully finished his first case and started on a second when his voice rose with uncharacteristic concern. “Geoff! Could you come take a look at this?”

  Tabin threaded his way across the crowded room, holding his gloved hands aloft, careful to keep them sterile.

  “I think I might have stitched this one on upside down,” Nkurikiye explained.

  “That’s easy to do,” Tabin said. “What happened?”

  “I may have turned the tissue over after I removed it from the solution. I don’t think so, but I can’t be certain.”

  “You always have to keep the orientation,” Tabin said. “Once you’ve turned it over, it’s hard to tell which side is up.” While Tabin looked through the lens of the microscope, I studied the patient’s chart. She was thirty-six, her name was Yvonne Uwamungu, and her intake form listed her as an elementary school teacher.

  “You can tell which side is up by looking for faint Descemet folds beneath the surface,” Tabin said. “I’m pretty sure you’ve placed the cornea correctly. Nice suturing, by the way.”

  “Yes, I also believe I saw folds. That is why I had the confidence to continue.”

  “Well, we’ll know for sure when we look at her tomorrow. Her eye will either be much clearer or much cloudier.”

  “Yes,” Nkurikiye said. “That is my hope and my fear.”

  For one hundred days in 1994, John Nkurikiye, a junior medical officer with the Rwandan Patriotic Front, experienced more hope and fear than any human could be expected to endure. Though that year’s genocide made headlines around the world, the Rwandans’ colonial masters had left them with a legacy of inequity that had led to regular outbursts of violence little known outside Rwanda for much of the twentieth century. Belgium, employing a brutal divide-and-conquer strategy that would make the most oppressive British colonial officer blush, had drawn an artificial line through Rwandan society to create an aristocratic class, indebted to their colonial overlords, and a peasant class that the elite were ordered to control.

  “Do you know how they did it?” Nkurikiye asked me, over dinner at an open-air Chinese restaurant clinging to the side of one of Kigali’s hills. “Look at those lights below us. Can you tell which belong to the homes of Hutu or Tutsi? That’s what it was like before the Belgians. We lived together peacefully, intermarried, and even we had trouble telling each other apart. But the Belgians made it simple. In 1933 they passed a law declaring that every Rwandan who owned ten cows or more was a Tutsi and the rest were Hutus. They issued identity cards to make it official, gave Tutsis greater rights and privileges, and planted the seeds of the slaughters to come. So you see why I hesitated to answer in Utah when you asked me what I was. By Belgian classification, I’m a Tutsi. But in actuality, I’m a Rwandan. Full stop.”

  In 1959, as Belgium prepared to grant Rwanda independence, it switched allegiances, elevating Hutu politicians to positions of authority and turning the prevailing power structure on its head. Hutu militias, in a campaign they called the “wind of destruction,” began systematically massacring Tutsis. More than twenty thousand were killed, and hundreds of thousands fled to neighboring countries. Nkurikiye’s family settled in a refugee camp in neighboring Burundi. “We were really second-class citizens in Burundi,” he remembers. “We hadn’t access to land ownership or professional careers. Primary education was provided. But we had to jump over a high post if we wanted a secondary education.”

  I remembered something a Burundian engineer I’d sat next to on the flight from Brussels had said about the Rwandan refugees in his country. “When I was growing up,” he said, “Rwandans were not even second-class citizens. They were poor people you would see digging ditches and doing odd jobs. My friends and I would mock each other’s clothes, if they were inferior, by saying, ‘Look at you! You’re dressed like a Rwandan!’ ”

  Nkurikiye, like Ruit, forged an unlikely path to higher education through sheer brainpower. As a standout student in the Muramba refugee camp, he was one of a handful of children allowed to continue their formal education. Through secondary school and university in Burundi, he topped every standardized test he was allowed to take and won a scholarship to medical school. In 1990, the Rwandan Patriotic Front, the Tutsi-led government in exile, launched a guerrilla war against the Hutu-dominated Kigali government from bases across the border in Uganda, and Dr. Nkurikiye volunteered to move north and join them.

  In April 1994, his unit was camped just north of the border, on high alert because the leader of the rebel army, Paul Kagame, didn’t trust a power-sharing agreement the U.N. had just helped bro
ker. French troops reinforced the Hutu-led military and had repeatedly helped them repel what they considered an invasion of a francophone nation by an anglophone power, never mind that the invaders were largely French-speaking Rwandan refugees.

  At 8:20 P.M. on April 6, 1994, as the presidential jet, a light Dassault Falcon carrying Rwanda’s head of state, Juvénal Habyarimana, who supported the peace agreement, began its final approach to Kigali International, a surface-to-air missile struck its left wing, followed by another that streaked up out of the darkness and shattered its tail. The plane crashed into the garden of the presidential palace and burst into a fireball. Who fired the missiles has remained a matter of debate. But whoever murdered Rwanda’s president also killed any hopes he’d had for peace.

  “We’d been hearing rumors for months that Hutu militias were stockpiling weapons and preparing to attack Tutsis across Rwanda,” Nkurikiye remembers. In Rwanda, where Tutsis are generally thought of as taller than Hutus, terror spread throughout the Tutsi population when Radio Télévision Libre des Mille Collines, a station run by the extremist Hutu Power movement, began broadcasting ominous orders that all patriotic Rwandans should prepare to “cut the tall trees.” Invoices collected after the genocide document that Hutu businessmen had imported 581,000 machetes into Rwanda during a two-year period before the massacre.

  “The killings started as soon as the plane crashed,” Nkurikiye says.

  “Almost immediately, we began receiving phone calls from Tutsis and Hutu moderates saying, ‘We are being killed,’ ” recalls the man who served as Nkurikiye’s senior officer, Charles Kayonga, currently commander of Rwanda’s Defence Force. “Sometimes even, we would be on the phone, hear them being killed, and the line would go dead.”