Adjusting to a New Reality

Sometimes you have to take the slow boat to China, or Mudende. Patience is not really part of a 23 year old’s repertoire of emotional or mental paces. Slothfulness, sometimes, but patience not so much. A recent Mutuelle outreach trip to Mudende tempered my ambitions and fantasies somewhat, but also gave me hope for the long term potential of CCHIPS and Rwanda.

On a beautiful Tuesday morning, we hoped to lead a Mutuelle (community health insurance) information session at Mudende. We drove the 20 minutes to Shingiro, picked up representatives of Mutuelle and several Shingiro nurses.

As we were about to leave Shingiro, I realized that the two pots of coffee and two liters of water I had consumed earlier would be catching up to me at some point during the course of the morning. Thinking nothing of making assumptions like: “oh, they’ll have a toilet at Mudende” I decided to wait.

We then drove the half hour up the winding, rocky, bumpy road to Mudende. The road is narrow and at times seems to shoot straight up the side of the hills. Elie remarked that the road was newly resurfaced, which is good because it’s hard to imagine driving on a less passable road.

I sat up front with Elie, and asked him about the people and plants as we drove. We passed fields of beans, potatoes, gooseberry, maize, eucalyptus, and bamboo. Elie explained that the altitude prevents the cultivation of coffee and that avocados grown here are much smaller than those grown in the south. The sun was bright and I waved to the constant stream of children who would run to the side of the road as the Land Cruiser rumbled by. It was a nice drive except for all the bumps in the road (and we’re talking softball to volleyball sized rocks here).

Mudende sits on what seems to be a peninsular hill jutting out into the openness of the falling hillside. As we made the final turn down the hill peninsula, we came upon a young shepherd and his flock of about a half dozen sheep. The shepherd stood on one side of the hill and his sheep on the other and as we drove past the sheep got out in front of the truck. They began running away from the Land Cruiser and down the path and we nearly herded them to Mudende. It was only a quarter mile and the shepherd ran behind us, yelling at us, the sheep, or whoever would listen. The sheep finally turned up into a field just before we entered Mudende.

As we arrived, I was in for my first “Muzungu Celebrity Experience”. Literally dozens of children began shouting “Muzungu! Muraho Muzungu!” and variations on that theme as they began chasing the Land Cruiser. We pulled up next to the community offices and we all got out. I didn’t know quite what to do, so I smiled and waved to the children. Soon, a police officer chased them away in a hilarious flock of giggles and yelling.

As is common in Rwanda, and I would guess most places with poor roads, communication, and little automobile ownership, everyone was late. We settled in to wait for the community to arrive so that we could begin our presentation. Unfortunately, as the only Muzungu in the group, this meant a lot of standing around and laughing along at jokes that I didn’t understand.

After a few minutes, I asked Rene if he could ask someone where a toilet was. He came back a minute later reporting that the nearest toilet was at the school we passed on our way in. The school was only a quarter mile away, but it also lay in the treacherous territory of the Lollipop Guild. I didn’t need 100 Rwandan school children watching me pee – talk about stage fright.

We waited some more as Elie went to find out why there were no locals present for the meeting.

I took this opportunity to take in the view. The town overlooks a large valley, stretching out into the haze. Rwanda is a beautiful country, all green and brown. And yet the beauty of the landscape clashes forcefully with the poverty of its rural population. From a distance, the tin roofed huts and the smoke rising from cooking fires and slash-and-burn agriculture present a beautiful image. Rustic. For an American, it stirs within the myths of our American frontier. But when you approach one of the tin-roofed hut s and you are greeted by a small child with the big belly that signifies not over-indulgence but such malnurouishment that his body is too weak to keep his organs tight below his chest cavity, well, the myths disappear. Reality sinks in. The need is immediate, but the obstacles are many and, at times, desperately frustrating.

Elie returned and reported that no one had canvassed to spread the word about the meeting. We would need to reschedule. However, before we could reschedule we needed to wait for another member of the Mutuelle team to arrive.

I squirmed as we waited some more. Elie is a gregarious guy, so he kept everyone entertained. All the Kinyarwanda speakers anyway.

I began to circle the cell office. I noticed, excitedly, that on the back of the building seemed to be several latrines. I tried each door down the line. Locked. Locked. Locked.

I returned to the group talking and asked Rene about a toilet. He pointed to a man coming out of a small group of trees. “You can probably do that.” I considered it, but Rwanda is very densly populated, especially around the cell office. No, best not be the foreigner that comes in and pees on the country.

I returned to the group again, and noted that there was not a large group of residents waiting, but there were 15-20 elderly people waiting. I asked Elie about them. He said that they were not here for our Mutuelle presentation, and wanted to meet with cell officials to discuss other matters. Fair enough, I thought, but they look bored, we were certainly bored, why not talk to each other about Mutuelle anyway? I asked Elie. Politics. We didn’t want to step on any toes by appearing to take these people’s attention. I understood, and was grateful for the informed local perspective. But, still, frustrating.

Waiting...

Rene tries the tardy Mutuelle official’s phone, with no response...

Waiting…

She arrives! We can go! But first, the team decides we should look at the Twa resettlement project located next to the cell office. The Twa, sometimes referred to as a pygmy group (though they seemed normal height to me) are the smallest of Rwanda’s 3 “ethnic” groups.

We went and surveyed the Twa settlement. A broken door and they need a latrine. So did I. I died a little inside as my bladder nearly ruptured.

After 2 hours of sitting around, we finally left.

On the way back, we passed through the small town of Gwanda Riushya. Hikers park their vehicles here before they climb the nearby Virunga range volcanoes. With the Mutuelle meeting date for the next week set, we decided to inform the locals. We parked the Land Cruiser, and a group began to grow, curious at what we were doing/would say. Rene smiled, “this is grass roots organizing.” Note to self: Grassroots organizing is easier when your presence draws a crowd.

Rene and Elie said a few words and we were off again.

Now began the serious descent to Shingiro. I was smushed in the back of the Land Cruiser with 8 other people. The back of the Land Cruiser has narrow benches on either wall, facing each other. Maximum capacity, Zack has told me, is however many can squeeze in. So I guess I should have been happy that there were only 8 people in the back. As my legs fell asleep, this probably wouldn’t have been consolation. I am still learning things about the best place to sit in the Land Cruiser. On the way up to Mudende, I sat shotgun, which is the best spot. On the way down I discovered a basic rule of thumb for sitting on the benches in the back of the Land Cruiser: when you are mostly going uphill, sit near the front. When you are going mostly downhill, sit near the back. The key is to ride on top of everyone else, and not be ridden.

The dreaded back of the Land Cruiser.

Unfortunately, as we descended toward Shingiro, I was in the front of the back, with 3 people uphill of me. Ugh. At this point, the combination of altitude and my desperate need to relieve myself was inducing some serious claustrophobia. Rene sat in front, happily snapping pictures with my camera. We slowed down several times for him to get better shots of Shingiro from above. My bladder screamed: Ahhhhhhh!

Finally, in a ride that seemed like an hour instead of twenty minutes, we rolled back into Shingiro. I ran into the new Global Fund building, and found the restroom. How do you spell relief?

I met up with Monique who was taking notes on a community health worker (CHW) training session. After our utter lack of turnout at Mudende, I was reminded that with trained CHWs and a system for deploying them, such a problem should never occur again. After a seemingly wasted morning at Mudende, I have the personal experience to know the value of such a system.

While I came away from the morning with my grand ambitions somewhat tempered, I took from the experience a perspective which will allow me to actually have an impact. The wild dreams and fantasies are gone, mostly. I know more of the reality of Rwanda – its poverty, its frustrations, but also the enormity of good that can be accomplished.