Second Suns

by David Oliver Relin

  Athanase had a remarkably sunny disposition for a man who’d survived so much, and I asked him why. “My wife convinced me we can’t spend the rest of our lives blindly suffering,” he said. “That’s why I’m here. I’m ready to see again.”

  So was Eminante Uzamukunda.

  “Come, you must talk to this girl,” Kiiza said, hurrying me along. “She’s very intelligent.” I picked up her chart. It listed her age as eighteen and her profession as “student, interrupted.” She had close-cropped hair, a wide face with sculpted cheekbones, and wore a torn T-shirt and a sun-faded wrapper. She slumped so low in her seat that, at first, I presumed she was unusually short. Next to her sat a ravaged woman who could only be her mother; she offered a preview of what Eminante would look like after twenty more years of poverty.

  “The girl is able to be of no help at home,” her mother said. “She can’t cook or care for the other children. She just sits inside all day.”

  I asked Eminante how long she’d been sitting at home, and she said, in a voice so soft Kiiza had to ask her to speak up, “Some years. Since I left school. My eyes were decreasing in capacity for a long time. But when I became blind my mother said school is too expensive for someone who can’t see, so I went home.”

  I had expected to hear that she’d lost her sight recently. But she had been sitting in her home, without stimulation, while her siblings continued attending classes, for several years. I asked what she missed most about school.

  “Drawing,” she said. “And reading. I miss reading so much. Sometimes my sister reads to me, but we’re very poor. Everyone is obliged to work at our house, and there isn’t much time for books.” I asked the cost of a year’s tuition. “Oh, a lot,” Eminante said, naming a number of Rwandan francs that equaled eight dollars.

  We all worked until after dark for the next four days, drove away in our convoy, and ate dinner together in open-air restaurants atop Kigali’s hills. Nkurikiye wore a bright yellow dashiki to one meal and a handsome dark brown version to another, explaining that members of Rwanda’s military were forbidden from appearing in uniform at any place that served alcohol, to avoid any implication of corruption. We had Indian food one evening, Italian the next, and we returned to the Chinese restaurant, Nkurikiye’s favorite, the following night. The cost of any one of those meals could have sent Eminante and all of her siblings to school for at least a year.

  I dealt with my discomfort about what Fred Hollows would have called “the disequity” by trying to be helpful in the operating room, by performing the small tasks Chansi had taught me. One day while I was walking a patient into surgery, I saw two large, muscular men in U.S. Army camouflage standing in the hallway, jotting down notes. The American military had begun to take an interest in Tabin’s work, hoping he could help its forces do a better job of organizing their humanitarian medical outreach, and these two officers had been sent from a base in Djibouti to observe Tabin’s methodology. I found them scrubs and surgical masks and led them into the operating room so they could look more closely. They were clearly moved by what they saw inside. The soldiers left with their notebooks filled and numerous compliments about the efficient assembly-line surgery they’d witnessed.

  After a shaky start at King Faisal, Tabin’s daughter Emilia threw herself wholeheartedly into making sure the OR ran smoothly. She worked closely with her father, leading patients to and from his table and double- and triple-checking their charts to make sure Tabin had lenses of the correct power to implant. Emilia had been a champion Nordic skier and a standout student of the liberal arts at the University of Vermont, but a visit to Nepal—and the opportunity to watch Ruit at work—had changed the course of her life, as it had changed her father’s. “You know,” she told me, “I never had any interest in medicine until I saw cataract patients in Nepal after surgery. If I have a chance to do something like that, I think it will be a pretty satisfying life.”

  As he operated on each of his patients, John Nkurikiye certainly seemed satisfied. He worked with confidence and unusual grace. The signs at Nyamata hospital were in French, and the door to the recovery room read, RÉANIMATION. I preferred to read it as English, because the hunched and withdrawn patients we brought there came back to lives full of possibility. I had just placed Eminante on a hospital bed, making sure her head was comfortably propped up on a pillow, when Kiiza burst into the reanimation room. “Quickly,” he said. “Dr. John is asking to see you!”

  I jogged to Nkurikiye’s table. He was concentrating and not yet able to talk. I glanced over at Tabin, whose patient had deep slash marks on her legs. Half of her left foot had been cut cleanly off, on a diagonal. I looked away and watched Nkurikiye work until he was ready for me. He preferred a variation on Ruit’s technique, inserting a fine steel probe shaped like a tiny spoon and drawing out the cataract by cupping this tool under the diseased lens.

  After he’d delivered it, he took extra care to clear up every single scrap of cortex, the filmy residue left after a cataract is removed, which I’d seen some developing-world doctors ignore; I couldn’t find a speck left when Nkurikiye slid one of Tilganga’s high-quality artificial lenses into his patient’s eye.

  When he was done, Nkurikiye drew aside the corner of the green surgical drape so I could see what lay beneath. His muscular patient was clothed in a pink prison uniform. “This is one of the people we were discussing,” he said, and for the first time since we’d talked about the genocide, Dr. Nkurikiye’s voice was pregnant with emotion. “You know what he is, and yet I am treating him. So, you can see that this is our relationship. This is our reality. This is Rwanda.”

  Since I’d been writing about Ruit and Tabin, the incomparable moment each morning when a patient’s bandages were removed and they were again able to see had made whatever hardships we’d encountered while traveling seem worthwhile. The emotions that ceremonial procedure released convinced me, each time I witnessed it, that Tabin and Ruit had chosen their careers wisely. But in Rwanda, only fifteen years “after,” emotions were still held close, like hands of cards people didn’t want others to see. When we removed the bandages of the patients at Nyamata hospital, they hardly reacted at all. Sezikeye Athanase blinked, and his face remained blank. When I showed him a photo of himself, he studied it briefly, then said, “I need a new hat.” A middle-aged man whose name was certainly not Buddy, though that’s what it said on the chest pocket of his cast-off work shirt from Standard Compressor, in Lubbock, Texas, looked straight through me when he was finally able to see well, after five years of making out only shadows, and didn’t say a word.

  Eminante was an exception. When Tabin pulled the patches from her eyes, she giggled at his foreign face and manic behavior. While he held up two fingers and asked her to count them, she had a hard time stopping her laughter long enough to answer. As she looked at the stained T-shirt she wore with a cartoon image of Tigger the Tiger, at her mother’s lined face, at me, leaning in to take her photo, she grinned and grinned, like a girl unwrapping one unexpected present after another.

  That afternoon I drove home with Eminante and her mother in Nkurikiye’s SUV. During the mile or two we traveled, neither of them could stop laughing at the experience of riding in a motorized vehicle. Their small house was made of mud daubed onto a frame of cut branches, and the clothes of Eminante’s six siblings were streaked with the red clay soil of their village. Leading us to meet the rest of her family, Eminante bent to greet a gentle dog lying in the shade at the side of the house with his legs in the air. She stroked his belly, rose, and touched each of her siblings’ faces, in turn, with her fingertips, then pressed her palms against the solid walls of her home, as if she were still seeing with her hands rather than her eyes.

  Her seventeen-year-old sister, Muteteli, who could have been her twin, studied us suspiciously. Their yard was fenced off by a hedge built of braided thornbushes. An outdoor kitchen, little more than an open fire pit topped with thatch, stood among a straggly grove of banana trees. There w
as no electricity, no furniture, and little to see inside the home. Eminante showed us the raised platform, built of mud, where the entire family slept. I noticed sacks of rice and beans stored in the rafters, to keep them from the rats. As we walked through a narrow passageway to the house’s second room, Eminante stopped, in mid-stride, and opened her mouth.

  Hanging from a rope, attached by clothespins, were several of her sister’s pictures. They were simple sketches of village scenes—a mother nursing an infant, a woman with a child tied to her back working in her garden, a girl in a bright purple dress dancing ecstatically—done with crayon on lined notebook paper. Eminante held each tenderly in turn and stared and stared at them. She had been living in monotonous darkness for far too long, and now art had returned to Eminante Uza-mukunda’s life.

  “I want to see if I can still draw,” she said.

  As her sister went to look for paper and crayons, we said good-bye and left Eminante to her reanimation.

  Before we left Nyamata, I sat with Edward Macumi, the patient Nkurikiye had called me in to see. He told me he was fifty-eight and came from Butare, in the south of Rwanda, but he’d been incarcerated near Nyamata, which was inconvenient for his family to visit.

  I asked him why he was in prison. “I didn’t kill anyone,” he said. “I was with some people who killed, but I did not.” He said he’d been sentenced to fifteen years by the gacaca and forced to do difficult agricultural work, even though his eyesight was poor. When I asked how it made him feel that the man who’d restored his vision was a Tutsi, he changed the subject. He asked me if I was able to get his sentence shortened, if I had a spare set of clothes I could lend him, if I could arrange for him to be transferred to a prison closer to his family. I said I could not. Concluding that I was of no further use, he looked away from me and shut off like a light. “It’s an injustice,” he was muttering as I left him, “an injustice.”

  “Are you ready to go?” Nkurikiye asked. “I’m sure that you’re as tired as myself.” Over the course of three long days, he and Tabin had completed 263 surgeries. They still had to check on the progress of their corneal transplant patients and meet with government officials about the eye center Nkurikiye hoped to build, before we’d be leaving the country.

  “What did he say?” Nkurikiye asked on our drive back to Kigali, after we left the bridge where he’d been wounded in our rearview mirror.

  “That he hadn’t killed anyone.”

  “Ha ha! He said that? I’m sure he did it. It was difficult not to do it. For your own sake. The groups got carried away and became like animals.”

  “On the subject of the genocide,” Kiiza said, “I’ve been thrice to see the gacaca, and I think it is fair. The people said something animalistic came over them and begged forgiveness. In a way, I think all of Rwanda went crazy. What are you going to do, kill everyone? I’ve seen many perpetrators become good people and do good things. In the end, we must have mercy.”

  President Kagame was in America, on his first official state visit to meet President Obama. We drove in a convoy of Land Cruisers stamped with the seal of the Rwandan Defence Force to meet with the country’s second-in-command, Prime Minister Bernard Makuza. Nkurikiye had changed outfits once again, and arrived in his gray dress uniform with red epaulets and a green beret.

  Tabin had also made an attempt to dress up for the occasion. His hair was neatly combed in the front, but wild in the back where he’d slept on it. He wore his usual pressed khakis, along with a new, sharply creased blue oxford shirt that he’d pulled out of its plastic wrapping for the occasion. The prime minister, wearing a well-tailored double-breasted suit, was waiting for us in the driveway, along with General Charles Kayonga, commander of the Rwandan Defence Force. Makuza made a brief statement to television reporters who’d come to cover the meeting. Tabin was asked to speak next. Just as he was walking toward the cameras, I noticed, snatched at, and missed a plastic label stuck to his collar that he’d neglected to remove. It said, 16 ½ BY 32.

  In Prime Minister Makuza’s elegantly appointed office, we sat on overstuffed chairs, surrounded by oil paintings of the Rwandan countryside. Tabin sat next to Makuza and launched into an impassioned speech without preliminaries. “I know that you have many offers of medical aid,” Tabin said. “But most of them are missionary groups who’re only here for a few weeks and often create more problems than they solve, because they leave their patients without care when they go home. John Nkurikiye is the best-trained ophthalmologist in sub-Saharan Africa. I’d like to duplicate our model from Nepal in Rwanda and make this a center of excellence for African eye care. With your support, my organization wants to help John build a world-class eye hospital and training facility here, run by Rwandans, to serve Rwandans, that will change eye care not only in your country but across East Africa.”

  Tabin was growing into his role as diplomat, with only a glitch or two in his professional comportment. I looked down and noticed his feet, tapping impatiently on the thick cream-colored carpet as he talked. He wore red Adidas trail-running shoes and mountain-biking socks that barely covered his ankles. But that didn’t seem to distract the country’s leaders from hearing the heart of his message: that they had a precious resource in Nkurikiye and he needed support. Tabin had learned not only the means of restoring sight from Ruit but also the ability to inspire visions of excellence in others.

  Tabin urged the prime minister to visit King Faisal Hospital the following morning and inspect the outcome of the modern corneal transplants Nkurikiye had performed. As we were leaving, General Kayonga pulled me aside and spoke with none of Nkurikiye’s reserve: “John was selfless and exemplary when he was under my command. But now he has a chance to be something bigger. My own brother was tortured and killed by the militias to try to break my spirit. But they failed. And if we allow Rwanda to be remembered as an island of evil in the center of Africa, we will have failed, too. There must be a reason for what we’ve endured. We must build something superior to what was here before the genocide. I guarantee you’ll get our full support. Because John can help us make Rwanda an example of how to be better.”

  The next morning, Prime Minister Makuza arrived at the ophthalmic clinic at King Faisal Hospital without an escort, to inspect Nkurikiye’s work; he’d driven his own jeep on a Saturday morning instead of playing the round of golf he had planned. Kigali’s TV reporters got wind of his presence and swarmed into the hospital soon after.

  Makuza watched a video of a surgery that Tabin showed him on his laptop, then walked along a row of eighteen seated patients, bending over, looking into their repaired eyes, and listening to their stories. The nineteenth patient was too enthusiastic to remain in his seat. Francis Kiiza had woken Nkurikiye at six, screaming into the phone with joy, saying he could finally see clearly. Kiiza pulled Nkurikiye to his side, clasped the prime minister by both shoulders, and began the sort of uninterruptible soliloquy I associated with Tabin. The television cameras closed in, assuring that his testimony would be heard nationwide. “You know, Mr. Prime Minister, loss of sight means loss of life! I had surrendered to remaining in the darkness before I came here. But now I have my life back. More operations like Dr. John is doing will help many more people like me survive!”

  After we left, Nkurikiye had an architect draw up plans for the center, modeled on Tilganga, that he hoped to open in Kigali. Six months later, as I was packing for another trip to Nepal, I received an email from Rwanda. Tabin had returned to Kigali in the interim, bearing a fresh box of corneas, and successfully sutured one onto Francis Kiiza’s other eye. The report I received from Tabin said that the preserved cornea he had initially taken so much pride in transplanting was looking “faaaaantastic!”

  “You are always on my heart and in my prayers,” Kiiza wrote me, “because I never expected to see again and He knows what you did for me. Dr. John is so good to me, and my sight has fully recovered. I am sending you a photograph of me in action.” I scrolled down to study it: Francis in a t
weed jacket and dress pants writing an equation far too complex for me to understand on a blackboard, while his students looked attentively toward him. “I am planning to enroll in a master’s program and hope to be a head of school someday,” he continued. “You should know that my life has been entirely transformed. May sweet Jesus watch over you in your travels,” he wrote. “And,” he added, in a sentiment that Tabin seemed to have stitched into him, along with his sutures, “remember to have fun!”

  When I’d met Cliff Tabin in his lab at Harvard, he had expressed concern that his little brother might be wasting his time in Africa. “I’m worried that Geoff’s diluting his efforts,” he said, which sounded, to my ears, much like Ruit’s warning against trying to do everything at once. “I don’t know if he can succeed in Africa. It all depends on getting the right partners. And I don’t know if Geoff will ever meet his African Ruit.”

  I thought about the eighteen or more family members John Nkuri-kiye had lost, and I looked at the eighteen seated patients, reanimated by a doctor’s unusual dedication. Cliff Tabin of Harvard Medical School was among the brightest minds in American medicine, but on one point, at least, he was dead wrong. His little brother wasn’t wasting his time roaming Africa, searching for a partner capable of helping him transform the eye care of an entire continent. He’d already found him.

  Hands, Eyes, Heart

  And now here is my secret, a very simple secret. It is only with the heart that one can see rightly; what is essential is invisible to the eye.

  —Antoine de Saint-Exupéry

  “You should have died sooner!” the dignified middle-aged Nepalese man shouted at the elderly corpse. “You should have left us long ago!” The manager and uniformed bellboys in the lobby of the Kathmandu Guest House seemed shocked by the display of emotion. A reasonable-looking local citizen was yelling at a television broadcasting the funeral procession of G. P. Koirala, the leader who had dominated Nepal’s politics for decades. “Now,” the man said more quietly, conscious of how his outburst had silenced the bustling lobby, “at least we’ll have a chance.”