Strength in What Remains

by Tracy Kidder

Deo told Innocent that I was afraid to go on. Innocent told him, “I’m afraid, too.” He told Deo, in so many words, “You know, I don’t care about myself. Right now I can easily go to Bugendena without you, but I’m just thinking how you survived and now you’re going back looking for trouble. Do you know how many people struggled to survive and didn’t survive? And now you are coming back here on purpose? It’s like you are laughing. This is a stupid idea.”

  Deo later explained to me, “Innocent was thinking deep about it. And he was warning me. He was just like referring to all these old beliefs, you know?” That is, Innocent accused him of tempting fate or the devil, putting us all at risk by incurring the wrath of the spirit world. I thought I understood. Deo was behaving like one of those arrogant ancient Greek heroes who, victorious in a battle, succumbs to hubris, claims he’s mastered fate, doesn’t fear Atê’s retaliation, and for his stupid boast gets visited by Nemesis. I was inclined to agree with Innocent.

  As we drove back on the orange dirt road in silence, I thought that I should start talking about bricks again. Just to change the subject. For the time being, though, I couldn’t manage even that. When we hit the paved road, I began to feel relieved, but then Deo insisted that we stop again at the memorial in Kibimba. This time the small shrine made me think of a diminutive Greek temple, on its way to becoming a ruin. Deo took some photographs, as vehicles and bicycles passed by—as, I imagined, the drivers and riders glared at him. When he got back in the SUV, he stared at the message written on the front of the memorial, “PLUS JAMAIS çA!” He sniffed, and said as others had before him and others no doubt would again, “I have learned never to say, ‘Never again.’”

  SIXTEEN

  Burundi,

  2006

  Every day in Burundi, Innocent drove us to places that seemed inhabited with Deo’s memories, waiting for him to return. The country’s lone medical school was an obligatory stop. The Coca-Cola stand was still there, marking the spot where he’d climbed off the army truck when he’d finally made it back from Rwanda. And here across the street was the medical school’s main building, where he had studied so assiduously. The building was massive and still looked rather new. “It was so beautiful!” Deo cried, gazing up at it, his eyes fixed on a great vertical crack that some sort of artillery had made in a concrete wall.

  In his day, he remembered, more than a hundred faculty had taught here. The school was functioning again but, he said, with only seven full professors. He wanted to go inside. A pair of custodians obliged him. The current students were on vacation. The place was empty. It felt like a ruin. A lock and chain barred the way to one wing, which was in danger of collapse. Tattered curtains hung in the classrooms where Deo had received lectures on basic physiology, pathology, pharmacology. In the laboratory where he’d first seen bacteria swimming in a petri dish, there were no microscopes anymore—all stolen, the custodians said. There were no textbooks or slides for students to study, no slide projector for that matter, and only a small collection of tattered medical journals, which a sign on the library door asked students not to photocopy lest they be damaged.

  We walked over to the university hospital, the teaching hospital. I could imagine Deo in a white coat, a student on rounds. As we passed through the rooms, rooms that used to contain only two beds but now had six crowded together, he smiled at patients, offering greetings to each. He stopped at the bed of a young woman. A plaster cast covered one of her legs, from toes to hip. He asked her for her story. She said she’d been tending her bean plants in her roadside garden and had been hit by a passing car, which hadn’t stopped. Kindly neighbors had brought her here, but she had spent her life savings, such as they were, for her medical care, such as it had been, and was now in debt.

  That woman, Deo said as we walked away, would soon be discharged to a special section of the hospital, equipped with security guards. She would be prevented from leaving until someone paid her bill, and in the meantime would receive no nursing and not even food, unless a friend or relative brought some to her. That was how the medical system dealt with unpaid bills these days.

  Detention of indigent patients—imprisonment, really—wasn’t exactly the fault of the new Hutu-led government. Given time, perhaps, the new administration would end the practice, which had begun under the previous, mainly Tutsi government. The World Bank and other international financial institutions had insisted, as they had through much of Africa, that Burundi’s medical facilities impose “user fees.” Some time back, in its zeal to collect those fees, this very hospital, the place where Deo had trained, applied the policy to corpses. The authorities refused to release the bodies of people who died with unpaid bills. Deo had heard the rest of the story, and he told it with a certain grim satisfaction. The morgue was unrefrigerated; when the air in the neighborhood became unbearable, the city’s mayor ordered the bodies released. The bankrupt patients were buried, Deo had heard, by prisoners who couldn’t refuse the job.

  While visiting hospitals on his last trip to Burundi, Deo had met a total of thirty-eight patients in detention at two hospitals, and he’d learned of more than a thousand others in different facilities. Of the detained patients he met, a woman with burns covering half her body stood out for him, as did an elderly woman with a soulful, mournful face. He photographed that elderly woman, then bailed her out, for fifty-seven dollars. He had already made an appointment to talk to the minister of health about his plans for building a clinic. He decided to take the elderly woman along, so she could tell the minister her story.

  The security guard outside the minister’s office stopped him. “You can’t bring her in here,” he said.

  Deo told the guard that the old woman was the minister’s aunt. “The minister will be so happy to see her!”

  Deo told me, “If I were living in Burundi, they would have sent me the same day to jail.” But the minister, a woman, did listen. The elderly woman had a beautiful face. In Deo’s photograph of her, I thought he had captured some of the essence of dignity and sorrow. Maybe the minister saw something like that as well, in the sad, stoic, weathered face across her desk. At any rate, on the following day, 150 detained patients were released from various hospitals. But the policy remained. Before long, 150 new sick detainees would replace them, Deo figured. When he got back to the United States, he thought of trying to raise enough cash to free all the patients, then realized this would only make detentions more lucrative for hospital administrations. For weeks he stole time from his studies at medical school, trying to write a paper on the issue, but to his relief he had recently been upstaged by a detailed exposé from Human Rights Watch.

  Many friends and family wondered why Deo kept coming back to Burundi. Many, including his mother, said they wished he wouldn’t tempt fate in this way. To me, he said, “But it’s my country no matter what. You know?” And as in almost every setting of great poverty, health in his country was dreadful. He had gleaned Burundi’s statistics from various sources. These were some he liked to cite at fund-raisers for his yet to be built clinic: an average life expectancy of about thirty-nine years; one in five deaths caused by waterborne diseases or lack of sanitation; severe malnutrition for 54 percent of children under five; for women, a one-in-nine lifetime risk of dying during childbirth; and fewer than three hundred doctors to serve a population of about seven million. And most of those doctors practiced in the capital. Many didn’t see patients in public facilities but worked for foreign aid organizations because the salaries were far better.

  I think this was Deo’s favorite part of the tour he led me on, the part that had to do with public health and medicine. These, I think, were the subjects around which time could reassemble for him, around which past and present and future could begin to seem coherent and purposeful.

  It was on our visit to Sangaza that he began to tell me the story of his first attempt to build a clinic, when he was a schoolboy years ago. It seemed as if the story all came back to him there at the site of that attempt—wit
h amusement added, most of the pain of failure withdrawn.

  Near the end of his junior year at high school, Deo had said to a bunch of his friends—no doubt one could have heard his father’s and grandfather’s voices in his—“Instead of wasting time walking around chins up, why can’t we build a clinic in Sangaza?” “Chins up” was Deo’s term for arrogance; because places in high school were rare, students tended to lift their chins at the thought of manual labor. He won over half a dozen friends, and led a small schoolboy delegation to visit the governor of the province. The governor agreed that if they managed to put up the walls of a clinic, he would supply the metal roofing. Deo talked his father into giving him a little time away from cowherding duties, and the week after school let out, Deo and his friends made bricks. Deo persuaded some of the local women to cook meals for the work crew.

  They made a great number of bricks out of wet clay. But they didn’t know how to fire them, and they had no money to hire someone who did. A thunderstorm turned all their bricks back to mud. Deo overheard adults talking about “those kids”—kids who didn’t know what they were doing, who were just wasting time, just trying to avoid their chores at home. He realized he should try to get the community involved. In the fall of the following year, right before school started, he organized an election in Sangaza. A clinic-building committee was chosen, another largely student work crew assembled. They made more bricks, and this time Deo and the committee managed to get a local craftsman to fire the bricks for a nominal fee. But they had to build a kiln first, and that took many days. By the time the bricks were being fired, the rains had begun. When the rains ended months later, the tall pile of partially fired bricks had collapsed, partway back to mud again.

  So Deo and his friends decided to build out of wood. The first week of the next summer vacation, they started cutting trees from the forest next to the graveyard in Sangaza. They cleared a site and carried logs to it, singing traditional work songs. But they hadn’t cut nearly enough wood to begin construction before his father’s dispensation ended and Deo had to return to cowherding. He had told himself that he would get back to building the clinic someday. And now he was—about sixteen years later, and in Kayanza.

  Deo’s impulse to public service had been planted by his mother and shaped by Bishop Bududira; in our travels in Burundi, Deo made sure to stop at the small memorial to the bishop, adorned with plastic flowers, in a corner of Bududira’s former church. And Partners In Health had given Deo confidence: no one could have worked for that organization without believing in the possibility of building public health systems and hospitals in desperately poor places. When PIH had expanded into Rwanda, Deo had hoped they’d also go to work in Burundi. But now he knew they wouldn’t, not right away. The organization was already overextended, with large projects all over the world. He knew that Paul Farmer hoped he wouldn’t try to build a clinic on his own, at least not before finishing medical school. But he also knew that if he forced the issue and got a facility started, PIH would help him. Farmer was already giving him advice and had promised to visit the site later in the summer.

  At Partners In Health, I think, Deo had discovered a way to quiet the questions he’d been asking at Columbia. That is, he saw there might be an answer for what troubled him most about the world, an answer that lay in his hands, indeed in his memory. You had to do something. And trying again to build a clinic must also be a way, I thought, for him to reach back to his former life and connect it with his new one.

  We were sitting one night in an outdoor bar, taking a break from touring. As often happened wherever we were, Deo began talking about his plans for Kayanza. It wasn’t my place to worry, I suppose. But I did. He didn’t yet have an organization that would finance and construct and staff the clinic he imagined. In fact, he was still trying to decide on a name. He would come up with one, declare emphatically this was it, and then for one reason or another reject it. In the bar, he finally settled on “Village Health Works.” I was glad to have the matter settled—for how long I wasn’t sure.

  The night air was fragrant; I smelled jasmine. The third round of beers had arrived at our table. Deo said, “So my pipe dreams are these. If the Kayanza project is successful, we can expand around, and people will see, ‘Oh it works, it’s good.’ And hopefully the whole country will begin to understand that you can do this without bringing a hammer, because once you bring a hammer, people will bring a shield, with another hammer to break your legs. How can we be healthy and a good society? We can train nurses in Kayanza and expand all over the country. Let the population know: ‘Look, this is what life is.’ And those people, they will teach other people, make people see what is right. And show them the value of work. And that would erase, not the history, but it would create a new world, make it peaceful and a wonderful paradise. It’s a really small country. There is no reason why it should be impossible, no reason at all.”

  He had been smiling, a faraway look on his face. It faded. “I know I have these unrealistic beliefs and thoughts, that the world can be peaceful, can be healthy, people can be humane. But is it feasible?”

  “Well, you won’t know unless you try,” I offered.

  “Right. And if you try … Sometimes I think, ‘Am I crazy?’ You try to save someone and you get killed, by that person. You stay away, you get troubled, because you are not doing something you believe in.” He laughed. “In the middle of the ocean, and I always have these thoughts. Goddammit!”

  “So here we are off to Kayanza!” cried Deo as we turned off the paved highway beside Lake Tanganyika. A deeply rutted dirt road led through a palm grove, a dark and mysterious maze, orderly, fecund. There were seven of us crammed into the SUV. Deo’s American medical friends had come with us on this trip, too. This was what they had traveled to Burundi for, to help him get started on the clinic. This trip to Kayanza would be the summer’s opening ceremony, as it were. I was looking forward to seeing Kayanza, Deo’s adopted hometown, which had clearly replaced Butanza in his affections. More than that, I was looking forward to meeting his parents.

  He had told me some of what he knew about their recent past. His father had come all but undone during their several years as refugees, and the nightmarish years of civil war they endured after returning to Burundi, and the loss of practically everything they had worked for all their lives, including most of their cows.

  The first time Deo returned to Burundi, on the trip he survived because he didn’t take the bus, he found his father drinking heavily and threatening suicide. Deo went back to the United States feeling he had to get his father help. It took a long time, but eventually he made arrangements for his father to see a psychiatrist, in Rwanda’s central hospital. Deo flew from New York to Kigali to be on hand. But when he met his mother there, she told him his father would refuse to see him. His father had told her he didn’t have anything to give Deo. Therefore, he could not see him.

  Deo grabbed a bunch of clothes from his suitcase and put them in a plastic bag, which he handed to his mother. “Just tell him these are clothes you bought for me.”

  The ploy worked. His father let him into his hospital room and said, his usual commanding tone restored for the moment, “I bought clothes for you. Here.” He handed Deo the bag. “Try them on.”

  That had been another wretched trip. Deo didn’t even get to Burundi. His uncle said it was too dangerous, and Deo believed him but also thought, “Too dangerous for me but not for my parents?” And the psychiatrist wasn’t much help to his father—less help than Deo’s mother, as it turned out. Back in the United States, Deo heard from relatives that one day, enduring another of his father’s threats of suicide, his mother had said that if he killed himself, she would follow suit. And it seemed as if his father awakened at least partially to his old self. In any case, he stopped making the threats.

  It was his mother, Deo heard, who had managed almost everything in the years after she and his father returned from the refugee camps and settled in Kayanza. She milked
their few cows and tended the beans and cooked the meals and took care of Deo’s two youngest brothers. And she managed their escape, the day when some neighbors warned them that militia were coming. For a time they lived in the forests near Kayanza. They came back to find their house burned. Deo’s youngest brothers remembered how anxiously she looked after them, at one point even paying other families in rather distant, safer villages to take them in. She would walk miles carrying food for the boys, food that the foster families often kept for themselves. When the boys decided to come home to Kayanza, she didn’t scold them, she simply wept. She and the boys were hiding in a field of maize the next time the militia came and burned their house again.

  Deo didn’t know much more about those years. He didn’t know exactly what his parents had endured in their trek across the mountains to Tanzania, in the refugee camps across the border, in the woods around Kayanza where they often had to hide. He didn’t want to know. On that first trip back home, he had learned that his mother had added to her two given names another: the Kirundi word for silence. He didn’t ask her the reason. One day some years later, she announced to Deo and one of his younger brothers that she was going to tell her story. Deo couldn’t bear to listen. Against all he felt was right and best for her, he turned and walked away, and in a moment his younger brother did likewise, in tears.

  But these were acts committed out of too much filial feeling, not too little. Deo had never turned away from his parents in any other sense that mattered. On the contrary, it was because they were in Kayanza that he had adopted the village as his own. The place was certainly remote enough to suit him, I thought, as the SUV lurched up and down on the rutted road through the palm grove. Then came a town called Rukomo and another rutted road. There were hot springs nearby, and a good-looking clinic that was underequipped and charged for its services and wasn’t much used. A European church group had built that facility, Deo said as we passed, but a Burundian pastor now controlled it. “He’s like huge, Bible in his hand, a suit, and five pens in his pocket, and a huge belly.” Some time back, Deo said, he had imagined a joint effort to improve the clinic, but the pastor had demurred. Deo remembered arguing: “If tomorrow you don’t have a large number of people coming to worship you, don’t be surprised. They will be sitting in their houses, in these miserable hospitals, dying. Give them something. At least that way they can show up on Sunday at your church.”