by Tracy Kidder
In effect, he became at once both an American citizen and a virtual expatriate, spending most of his time on the hilltop plateau of Kayanza, carrying rocks and planting trees and sleeping in a tent.
Deo had been greatly taken with the myth of Sisyphus when he’d encountered it at Columbia. “Pushing the rock” was his term for trying to build a not-for-profit medical facility in a desperately poor country. But the task was more nearly like the labors of Hercules, a succession of varied obstacles. He had to get title to the land, permits to import equipment and medicines, and nonprofit status in Burundi as well as in the United States, and to accomplish any of those tasks, he had to overcome the suspicions, even at first the hostility, of several Burundian officials.
Buildings had to be designed. Materials had to be purchased and trucks rented to transport them, and the trucks were always breaking down. Masons had to be hired. They also had to be supervised. So did one enterprising driver, who would siphon gas from his truck and resell it. And the person hired to supervise the work had to be supervised himself, and eventually fired, because he kept disappearing in the middle of the day to drink banana beer, taking the work crew with him. (One of Deo’s brothers, all of eighteen years old, took over the job; he had no experience but could work for free.)
Provision had to be made for sanitation and clean water and, someday, for electricity. Staff had to be chosen and trained. Money had to be raised to pay for all of that and more. And from time to time, Deo had to overcome his own disillusionment. He had imagined many difficulties, but experiencing them was different, sometimes like “a knife in the heart,” he said. He shouldn’t have been surprised or even upset, but he was both at first, whenever someone he’d considered an ally turned out to be interested only in personal gain.
Alone in his tent, he’d awake in the middle of the night, the world so dark and quiet around him that he’d wonder, “Am I alive?” In the half-awake state of infinite dire possibility, his fears seemed invariably to go to the partially constructed buildings of the clinic. He’d get up and survey the work site with his miner’s flashlight, just to make sure the buildings hadn’t collapsed, or been stolen.
Deo often complained that progress was slow. To me, it looked rapid. In what seemed like no time at all, he had made allies of many government officials, who on one occasion scotched an attempt by a group of soldiers to appropriate one of the clinic’s just finished buildings. Later, after a group of rebels—bandits, really—tried to raid Kayanza, the government provided a constant security detail. It was reported that the president himself had good words for the project. Friends at Partners In Health offered counsel and help with every conceivable problem and also training for nurses and community health workers. Members of Deo’s family did various jobs. A host of Deo’s American friends came over to work, while others raised money back in the United States. As for the villagers, Deo often said they were what kept him going—their misery on the one hand, and their wild enthusiasm on the other.
He had established a committee of villagers and given them a real say in the affairs of the clinic. Women and children were the majority in the community, so he figured that women, and through them children, should hold the majority in the committee. But the men dominated the meetings anyway. So, over vehement protests from the men, he abolished that committee and created a women’s committee and a men’s committee, and since then the women had taken over. It wasn’t as if many men didn’t pitch in, but it was the women’s committee that mainly organized volunteer work crews, advised Deo on the village’s needs and desires, and, perhaps most important, managed relations between the clinic and the village. When one of the soldiers guarding the clinic remarked, “We don’t have much to do,” Deo figured this was mainly thanks to the women. They had worked hard from the start, he told me. “But now they get to talk, too, and direct the clinic.” The women made up a song that the volunteer work crews would sing as they weeded the lawn and tended the gardens that were spreading all around the new buildings. The song went like this: “This project was brought here by Jesus Christ. We are thrilled. This project is beautiful. This place is beautiful. Kayanza is beautiful.”
Speaking at a fund-raiser in New York, Deo told this story: “This past summer, we needed some help to make a road that goes to our site passable. A friend of mine told me, ‘Well, Deo, there’s a great Belgian construction company that builds roads in Burundi and Rwanda and the Congo,’ and I was so excited. So I went to talk to the representative of the company. He sent someone to look at the road and estimated a cost of at least fifty thousand U.S. dollars. Not to pave the road, but just to widen it and make it passable. I went back frustrated, wondering how to tell the Kayanza community this bad news. As I was explaining this to them, one woman with a baby crying on her back said to me, ‘You will not pay a penny for this road. We become so much sick because we are poor, but we are not poor because we are lazy. We will work on this road with our own hands.’ The next day a hundred sixty-six people showed up with pickaxes, hoes, machetes, and other tools. One of the volunteers was a woman who came to work with a sick child. When a friend of mine and I looked at the baby, we saw that the baby was sweating. I then asked the mother why she came to work with a child that sick. And she said to me, ‘Well, I’ve already lost three children, and I know this one is next, whether I stay at home or come to work here. So it’s better for me to join others and make my contribution, which hopefully will help to save someone else’s child, who will be sick but alive when you have a clinic in Kayanza.’
“The entire road, six kilometers long, was rebuilt by these people with machetes and hoes. The same day the road was finished, the representative of the Belgian road construction company called me to negotiate the price. You can imagine how I felt to get that call from him. I said to him, ‘Thank you so much for your call, but it’s already done.’ He was obviously shocked and said to me, ‘What do you mean? Who did it? We are the only road construction company in the entire region!’ And I said, ‘Not anymore.’”
At the same fund-raiser Deo compared Kayanza to “a small sunflower seed, no bigger than the tip of my finger.” He went on, “But the sunflower seed, as everyone will tell you, has the potential to grow into an enormous flower that is bigger and taller than any of us here.” He imagined the spread of this enterprise, of a close alliance with the Ministry of Health, of an expansion to the large, underfunded district hospitals where someday indigent patients would no longer be detained. For the time being, though, the medical staff at Kayanza was obliged to sleep on the floor of the storage building.
But by November 7, 2007, when the clinic opened for patients, there were three buildings ready for use and a moderately well-stocked pharmacy. The pastor from Rukomo had objected to the clinic’s tapping the water pipe that ran from the mountains and through Kayanza, but the government had overruled him. Water now flowed into a brand-new, fifty-thousand-liter tank with its own internal filtration, enough to provide safe water for most of Kayanza and some of Rukomo. An African-American doctor named Dziwe Ntaba, an old friend of Deo’s, left his job in New Jersey and came to work full-time and for no pay at the clinic. For the foreseeable future the whole operation would depend on private donations—but by the winter of 2008 no longer entirely on flashlights. Paul Farmer asked a nonprofit organization called the Solar Electric Light Fund to take on Kayanza, and SELF found a donor named Lekha Singh, who gave the money to buy a generator and fuel for the time being, and also the money for a solar-powered, ten-kilowatt electrical system, to be installed by the summer of 2009. A company named Sonosite donated most of the cost of a compact, versatile imaging machine. Paul English, the founder of Kayak.com, provided computers and a satellite system so that Kayanza could manage its medical records and communicate with the rest of the world. And Paul Farmer persuaded national and international health authorities to make the clinic eligible for inexpensive supplies and drugs, including free medicines for AIDS and tuberculosis.
By t
he summer of 2008, Village Health Works had begun administering AIDS medications to fifty-seven patients. The clinic had an ambulance, beds for ten patients, and thirty-three community health workers. It had a growing vaccination program, a deworming program, and a program to curb malnutrition. It had six Burundian nurses and a Burundian doctor, as well as Deo’s American medical friends, and it had a new building for all of them to sleep in, in beds. The clinic was receiving an average of forty-seven patients a day, and sometimes as many as ninety—about twenty thousand individual patients in its first year. They came on foot and in the baskets that serve traditionally as stretchers—one man, near death, was brought encased in a bag, ingeniously strapped to a platform, itself ingeniously attached to the back of a bicycle.
Everyone who made it to Kayanza was seen for free, by a doctor or nurse. All were asked to pay for their medicines, if they could. Not always, but often, it was the best-dressed people, even people who drove up in their own vehicles, who claimed they couldn’t pay. The staff usually sent those people off with only a prescription, to fill elsewhere. The staff had lists of the poorest people in the area, and it wasn’t hard for Deo to spot the others who were truly destitute, as he circulated among the crowds that gathered outside the clinic every morning. It seemed as if the poorest were often the ones who would insist on paying for medicine, the ones to whom he and the staff would say, “No, no, go and buy some beans instead.”
Some patients traveled long distances on foot, usually in groups, some even from Tanzania, and some crossed the lake from the Congo and hiked up to Kayanza. Deo always asked these people, “How did you hear about us?” The usual answer was a phrase that meant literally, “When you’re miserable, you lose your head.” That is, a person in misery forgets to be silent and talks to everyone. Because those patients had long return journeys, it was decided that they would be seen first in the mornings. The women’s committee joined in creating this policy, and when some of the villagers objected, it was the women’s committee who explained and calmed them down.
Some people visited not for medical help, but only to look at the clinic. When Deo asked one of these travelers why he had come, the man replied, “To see America.”
This made Deo happy, since he was a full-fledged American now. But other testimonials seemed more important. For instance, from a driver who, Deo believed, was a former Hutu militiaman. After making a few trips to the construction site, the man came up to Deo and said he was puzzled. Ninety-nine percent of Kayanza was Hutu, but Deo was a Tutsi, wasn’t he? Told this was true, the driver walked off literally scratching his head. The next time he arrived, he volunteered to help out with the planting at the site. One elderly patient told Deo that he’d been fighting and killing Tutsis ever since 1965. The man had scars all over his body to prove it. He told Deo, “I wish I had spent my life trying to do something like this.” He was already getting free care and medicine. So Deo figured his words were at least partly sincere. He said to Deo, “If I could prolong my life, I would do nothing but work with you guys.”
A lot of people in Kayanza, it seemed, were astonished by Deo. One villager said, “Many others went abroad, but most of them have not returned to show us how we can improve our situation. We have never seen before an educated man like him hiking around in the mountains, up and down, to talk with people in their households. When we are working, he does not cross his arms. He works with us, so that the work can be done quickly. We hope that other people will see how he behaves, and then imitate him.”
One day a woman approached Deo with her head bowed and said, “You don’t know me, but I want to say that I am so sorry for what happened.” Deo suspected that she was confessing to some offense against his family during the war. Her words worried him. If people thought he planned revenge, they might try to kill him first. But it seemed to Deo that Kayanza was becoming a “neutral ground,” a place where Tutsis from the mountains and Hutus from the lakeside could mingle without fear. A place of reconciliation for everyone, including him. And he hoped he wasn’t dreaming. “What happened happened,” Deo said to the woman. “Let’s work on the clinic. Let’s put this tragedy behind us, because remembering is not going to benefit anyone.”
ACKNOWLEDGMENTS
My thanks to all of the people whose names appear in this book, and my thanks for various kinds of help to: Joyce Apfel, Robert Bagg, Jolanta Benal, Georges Borchardt, Alice Bukhman, Gene Bukhman, Evan Camfield, Ed Cardoza, Benjamin Dreyer, Paul English, John Farber, Elliot Fratkin, Bob Freling, Philip Gourevitch, Tony Grafton, John Graiff, Jonathan Harr, Chris Jerome, Frances Kidder, Nathaniel Kidder, Diantha Kidder, James Leighton, Alastair Maitland, Craig Nova, Rachel Rackow, Mike Rosenthal, Natasha Ryback, Haun Saussy, Mary Kay Smith-Fawzi, Basil Stamos, Sara Stulac, and Peter Uvin. I am also immensely grateful to a number of Burundians, but I think it best not to mention them by name.
Special thanks, once again, to Stuart Dybek and to Kate Medina. I also want to thank Richard Todd for all that he has done on my behalf, with a patience that has lasted thirty-five long years.
SOME HISTORICAL NOTES
The “ethnic” compositions of Rwanda and Burundi, past and present, aren’t precisely known. The estimates most often cited are based on a census conducted by the Belgians near the end of colonization. Subsequent estimates have been colored by the ideologies and interests of various governments and are therefore unreliable.
According to a widely respected historian of the precolonial era, Jan Vansina, the meanings of “Hutu” and “Tutsi” changed over the centuries but generally described “relative categories,” not geographical origins or clans or tribes. Certainly, most objective differences between Hutus and Tutsis had disappeared over the centuries before Europeans colonized the kingdoms of Rwanda and Burundi. Hutus and Tutsis spoke the same language and practiced the same religions. They shared the same taste for banana beer and the same proverbs and for the most part the same territories. They intermarried, too—more commonly after colonialism, at least in Rwanda. This ensured that by the time of Deo’s youth it was hard to tell Hutus and Tutsis apart simply by looks, stereotypes notwithstanding.
Before colonialism, though, other distinctions had been established. These were social, economic, and political. People who mainly herded cattle were called Tutsis, and “Hutu” had come to designate people who mainly farmed the land. There were many exceptions, and it wasn’t as if “Hutu” and “Tutsi” described genetic predispositions for plants and cows, but very broadly speaking, the aristocracy was drawn from the population of cow-owning Tutsis, and their inferiors or dependents were predominantly Hutu farmers.
By the late nineteenth century, before colonization, the categories Hutu and Tutsi had become “absolute” in Rwanda, Vansina writes. By the time the Europeans arrived, Rwandans were not only “conscious of a great divide between Tutsi and Hutu,” but the “antagonism between these two social categories had already broken into the open.”
In Rwanda, the king and aristocracy were Tutsi, and it seems the social hierarchy was more rigid than in Burundi. There, power lay less with the king than with the small princely class, descendants of kings, known as the ganwa. The ganwa and the king stood apart from the ethnic categories, and they ceased to be either Hutu or Tutsi. The various rivalrous groupings of ganwa needed all the support they could get, from Hutus as well as from Tutsis. Hutus occupied important positions, especially in the system of justice. So the oppression of Hutus in Burundi was both less onerous than in Rwanda and not as neatly identified as a Tutsi oppression. And the very complexity of Burundi’s social hierarchy also seems to have muted ethnic hostility. Tutsis were divided into at least two different classes, the Tutsi-Hima and the Tutsi-Banyaraguru, and both Hutus and Tutsis belonged to lineages of varying status. “Lineage affiliations,” writes the scholar René Lemarchand, “could rectify and even reverse the formal rank-ordering established through the caste system.”
But the European colonists administered Rwanda and Burund
i as one, and the effects of colonization, though not identical in each country, were profound in both.
In one of his books, Lemarchand quotes a German duke, who described the landscape of the colony Ruanda-Urundi in 1910 this way: “A hilly country, thickly populated, full of beautiful scenery, and possessing a climate incomparably fresh and healthy; a land of great fertility, with watercourses which might be termed perennial streams; a land which offers the brightest of prospects to the white settlers.” But comeliness was an incidental matter. The two little agrarian kingdoms were scraps in Europe’s carving up of Africa, potential sources of labor and further opportunities for the Christianizing enterprise.
Vansina writes that both kingdoms had known cattle raids and small wars. Colonialism appears to have introduced new levels of violence and tools for violence. A chronicle assembled by a Western scholar named Roger Botte contains many entries like this one, from the time of German rule:
1908. Burundi. From 31 March to 18 May, Grawert leads a new expedition against the princes of the northeast. This expedition provokes the Rumanymasunsu famine, which takes over the preceding famines and sweeps across the region. It reaches horrendous proportions because of the terrible losses incurred by the war—“the natives were slaughtered en masse with gun or machine-gun shots”—and the pillage of enormous herds—“4,613 head of cattle and 3,659 head of small livestock.”
According to Vansina and others, it is wrong to imagine, as some have, that the Europeans created either the distinction or the “mutual hostility” between Tutsis and Hutus. He writes, of the situation in Rwanda, “The Europeans merely adopted a practice they found on the spot and the terminology they used to express it derived from the speech of the local elites.” But the Europeans added poison to that terminology. To the Rwandan elites, writes the scholar Mahmood Mamdani, the distinction between Tutsi lords and subject Hutus had been conceived as an indigenous difference, a difference that existed among a single people, among relatives, as it were. The Europeans made the distinction into something it had never been, into a racial difference.