Learning How to Ride in a White Landcruiser

There was a time in Mauritania when I was the equivalent of a small African child and would greet the arrival of white landcruisers in town with an excitement typically reserved for presents on Christmas morning.

I remember one day in particular, when some Europeans arrived in my dusty desert outpost of Tidjikja. I was walking back from the clinic when a landcruiser glided by, and I caught a flash of white skin in the cool, air-conditioned interior. At that moment, it took everything I had in me not to yell “Nasraniya” and chase after the car with the same awestruck wonder that most Mauritanian children did. Instead, I picked up my jaw, which was hanging somewhere by my feet, adjusted my veil, and hurried home to share the news with the other volunteers.

As if it weren’t already evident from the above story, white landcruisers hold an iconic status in the minds of most Peace Corps Volunteers. While the sentiments attached to these vehicles may shift depending on country of service, the gist is usually the same – white landcruisers represent the outside world and a level of comfort not usually known to Peace Corps volunteers who casually throw around phrases like, “poo hand.”

In Mauritania, I unequivocally greeted their arrival with joy as their presence could only mean one of two things. Either a Peace Corps car had arrived with several months worth of care packages in tow - a regular Santa Claus on wheels - or adventurous tourists had stopped by en route to the ancient city of Tichit. Either way, it was something new to interrupt the daily doldrums of life and work in Tidjikja.

When I began work in Rwanda, my perspective shifted. In the wake of the 1994 genocide, the country was inundated by international development agencies and NGOs, and each of these organizations brought an accompanying fleet of vehicles with their colorful logos emblazoned on the side. Landcruisers were suddenly everywhere, even in my city of Rwamagana, and the urge to chase after them like a small child quickly vanished. Nor was my sponsoring organization – The ACCESS Project – a stranger to this creature comfort as we conducted daily field visits in our equally iconic white Toyoto Helix.

But somehow, the landcruiser retained an air of elitism in my mind despite their uncommon prevalence in Rwamagana. I was a Peace Corps Volunteer after all and that meant living life as part of my community. When the landcruiser and its occupants sped back towards the capital at the end of each day, I remained to eat tasteless ubugali with my family, play with my neighbor’s kids, and dread my icy cold shower in the morning. In the same vein, anytime I had to get anywhere else for non-work reasons, I crammed into the pea-sized, broke down mini-buses with everyone else and their mother (literally).

Given my perspective of the landcruiser culture heretofore, you can imagine my surprise then (mixed with some modicum of shame) when I crossed over that yawning gulf between Peace Corps Volunteer and development worker while working in Malawi this summer. It produced an odd sense of internal dissonance. Now I’m the one who speeds away from the dusty village in the white landcruiser, back to my friends in the capital, creature comfort food, and entertainment. No longer do I worry about scorpions creeping towards my bed in the middle of the night, as in Mauritania.

Of course, this is all to say that you never really leave Peace Corps. You leave the village, but you never surrender that perspective which enveloped you so completely, enabling you to welcome new and different people into your circle of family and friends and prodding you to not just explore, but to live a different culture. This same perspective is what drove me to learn what little Chichewa I could in the two months I am here and to observe what social norms I know of in Malawi. This, in contrast to certain expats who behave as though they live in Las Vegas and not the capital of one of the poorest countries in Africa.

Another hand me down from Peace Corps - I insist on living as frugally as possible. This standard has led me to rely on the local minibuses and my own two legs for transport while in the capital. These two options don’t strike me as the worst possible, especially when fares are as cheap as they are. But there are obviously some expats who would be very reticent to use local transport.

Case in point - at a party two weeks ago, I happened to meet some guys who invited me to go swimming with them at their country club the day after. I jumped at the opportunity, and, when they asked me where and when they should pick me, I replied that I would just catch the minibus which travels from my neighborhood to theirs. The two guys looked at me incredulously, asked if I really took the minibuses, and then broke into laughter. Suffice to say, I decided not to join them for the swim. Beyond my transportation choices, I must give the impression of being a Peace Corps volunteer in other ways as several other expats have assumed that I am a volunteer. Perhaps it’s the eau-de-poor graduate student that I put on each day?

While integration à la Peace Corps is no longer possible for me in my current position, I remain thankful that I at least recognize this shift in my perspective and am unafraid to live a life as part of a community – taking minibuses or walking, chatting with newspaper vendors, bargaining in the market, and sharing meals with Malawian friends in their homes.

My vacation this past weekend to Lake Malawi further demonstrated this new divide. At one of the lodges, I ran into some Peace Corps volunteers. They wore kitenge (wax print), spoke Chichewa with the local staff, and when they ate their cheese pizzas, you could readily observe how much they savored the food compared with their diets in the village. At the end of the day, we all left Cape Maclear. Tellingly, I packed into my friend’s SUV for the ride back to the capital, and they jumped into the flat bed of a truck, wrapped their faces with kitenge, and prepared for the dusty ride back to the village. We smiled at each other and waved goodbye. It was as if I was riding away in a white landcruiser.

Picture: Me and the members of my current project in Chinthembwe, Malawi - right before leaving to return to the capital

Malawi: The "Warm Heart of Africa"

3:57AM: The roosters crow way too early here. Momentarily roused, I drift back to sleep thinking, “that damn bird’s broken again” and dreaming of roosters strutting around with giant snooze buttons on their head. But then he crows again, and I’m forced to peak one eye open and blindly search for my phone. The room is still dark, but the moon is bright and casts a silver light through the gauzy white mosquito netting. My phone blinks neon blue in the dark, and I see that, indeed, it’s just as early as I thought it was.

That bird has been broken ever since I arrived in country. He crows at the ungodly hour between 3:30 and 4:00AM and then again 12 hours later in the afternoon. I’m pretty sure he and the rest of his compatriots need to be reset, if there were a way to do so, but I also know that this is the standard reveille for most Malawians. It’s something I learned my first day in country when my counterpart, in depositing me at my guesthouse, said “Okay, see you tomorrow at 7:30!” I thought it might be a one-time affair to arrive at work so early, but going on day 15, it seems to be the norm. The day begins and ends early, with most Malawians going to bed by 8:30 or 9:00. As Malawi, located in the Southern Hemisphere, is now entering its winter, I don’t know if this is just a seasonal quirk. Regardless, it’s a schedule, along with the roosters, which I must adjust to for the next few months.

Malawi – the little I’ve seen of it thus far - is a beautiful country. It has vegetation similar to that of Rwanda – friendly waving banana leaves, spiked palms, dense avocado trees and other trees which resemble some variation of an oak. It is hilly though not in any readily observable manner; the curves of the land are hidden by the dense vegetation. On the outskirts of the capital, the land immediately converts to farmland with wave after wave of maize and red-tipped long grass stretching out before you. I have yet to visit the famed Lake Malawi, but I know its waters will only compound the beauty of the country. Indeed, most of what I have observed outside the capital of Lilongwe has been on trips to my eventual site in Ntchisi. The district features a similar topography to the capital though it is, obviously, much more rural.

One thing available in my district which I have yet to find in the capital are field mice - grilled on sticks and ready to eat. Bon appétit! I really thought my friend, Malcolm, was joking when he mentioned this local delicacy. Even when my driver motioned to a small boy holding a stick by the roadside and said “mice,” I didn’t put two and two together. I looked to the ground and said, “No, that was a boy,” convinced he was confusing English words. He shook his head at the naïve American and smiled. It was only upon seeing another small boy by the road that I finally noticed the mice dangling from the stick he carried. We’ll see if I get up the gumption to try mice before I leave the country… me thinks not.

What I have seen of the capital, I have explored mostly on the weekends, as I don’t have much time during the actual week. Some friends and I ventured to a land dedication ceremony on Sunday and were treated to a local dance exhibition that reminded me of they way boys treat girls in elementary school. It was pretty fantastic, featuring giant papier-mâché animal replicas with male actors underneath who would occasionally break ranks to chase the female singers. A giant red, white, and black snapping turtle and what appeared to be an antelope would pursue the women after which the females would cautiously creep back towards the animals, whispering things behind cupped hands. Twenty-four hours after the fact, I’m still not quite sure what I actually witnessed. I’ve also made it out to a few dance clubs in town, which allowed me to watch men stalk women in a different way. Err, awkward…

In addition to my weekend explorations, I have also resumed my role of “the odd white girl who runs.” Waking at 5:30 each day, I’m able to log a few miles before I have to report to work and, in turn, provide countless Malawians with some early morning giggles and/or heart attacks. I have yet to hear anyone say to me, “What the hell is that?” as they routinely did in Mauritania, but there is one older gentleman who every day without fail will take a few wary steps back as he sees me approach and then scamper across the road to walk on the other side. I really want to smile and greet him with something akin to “I come in peace,” but instead we usually meet at the point in my run when I’m snotty, red-faced, and barreling towards the proverbial finish line. Perhaps this forthcoming week…

Though I’ve highlighted those rarified moments above when my “otherness” was readily apparent, in general, Malawians have been wonderfully cordial and welcoming. They have a slow, sarcastic wit that isn’t showy, but always makes you chuckle in retrospect. And the Malawians with whom I work seem genuinely honest and motivated to change their own circumstances and that of their compatriots. Having travelled throughout West and Central Africa, I wonder if perhaps I really have found “the warm heart of Africa.”

Making Water a Reality in Rural Health Centers

The room was bare - a green-sheeted examination table pushed up against the far wall and a large desk, cluttered with papers, bisecting the room’s length. A lone poster fluttered on the wall, moving every time the door swung open or shut. The lack of other adornment so typical of Western medical offices was not uncommon here at the Ruhunda Health Center. More striking, however, was the absence of a sink or even a bucket in which health center staff and patents could briefly wash their hands.

The general consultation room at Ruhunda routinely sees an average of 60 patients each day. This is where Juvenal Niyomugaba, the Vice Titulaire at Ruhunda, practices. Beginning at 8:00 each morning and working until 4:00 or 5:00 each evening, Juvenal consults with patients, treating them for a wide assortment of illnesses and conditions including respiratory illnesses, malaria, pre and postnatal consultations, and general wounds and skin infections. As they enter the room, he congenially greets them with a handshake and then proceeds to investigate their aches and pains or dress their wounds. Despite the otherwise professional nature of the visit, the health center’s lack of running water made it difficult for Juvenal to wash his hands between consultations except for the few moments when he was able to take a quick break.

“I am busy every minute of the day - in consultations with new patients, meeting with past patients, and performing administrative tasks,” said Juvenal. “I am a professional, so I know the importance of hand washing between patients, but how can I do it when there is no sink and no bucket to wash my hands with and I have to go outside to fetch water? It’s not possible.”

Unfortunately, this unsanitary and poor clinical practice was not singular to Juvenal’s service. Rather, it was an intolerable condition shared among all rooms and health professionals at the health center. Most notably, neither the delivery room nor the pediatric and adult consultation rooms at Ruhunda had access to running water. That any doctor would be forced to deliver a child without immediately washing his or her hands before and after performing procedures is unfortunate and reveals the sometimes perilous risks inherent to both practitioners and patients when water is not available.

Ready and reliable access to water is critical in determining the quality of care offered at health centers in Rwanda. Rwandans face a daily onslaught of pathogens and parasites which threaten their health in both small and large ways. Soil transmitted helminths, amoebas, and general bacteria and viruses exploit the country’s poor hygiene, resulting in increased morbidity and lowered productivity among both working adults and students.

Water is an easy remedy to these problems, especially in health centers where people are most vulnerable. Not only does water enable equipment sterilization equipment and hygienic care, but its presence in health centers also allows health professionals to role model good hygiene and hand washing.

Unfortunately, many health centers must operate without this basic service. According to the 2008-2009 Ministry of Health Annual Statistical Booklet, only 59% of health centers nationwide are connected to either the local or national water grid. The rest must rely on a combination of rainwater harvesting, surface water from nearby lakes or rivers, and wells and boreholes. Even those health centers already connected to a water grid must struggle to bring water inside their health centers; they are often forced to carry water in buckets from an outside tap on to the grounds of the health center. Before local Access Project Peace Corps Volunteers applied for and received water grants from Appropriate Projects, both Ruhunda and Musha Health Centers were among Rwanda’s many health centers without internal running water.

The villages of Ruhunda and Musha are both located in the Rwamgana District in the Eastern Province of Rwanda. Ensconced in the folds of gently rolling hills in rural Rwanda, they both host small communities of small scale and subsistence farmers. While both Ruhunda and Musha are relatively close to the nearest regional capital, Rwamagana – a mere 20 and 30 kilometers, respectively - the cities remain largely untouched by modernity. Although electricity and cell phone coverage are available, few in these largely agricultural cities use these resources.

But in March and April of 2010, the Ruhunda and Musha Health Centers took a critical step in their path towards modernization and improving the care they provide. With assistance from Access and its Peace Corps Volunteers, funding from Appropriate Projects, and the initiative and leadership of the health center titulaires, sinks were finally installed and connected to running water at both health centers, thereby eliminating previous practices of hauling water by bucket and sporadic hand washing.

The projects were organized and executed by Peace Corps Volunteers Colleen Laurence and Kara Rogers in coordination with the Rwamagana District Health Advisor, Charles Ngirabatware. The volunteers worked with Appropriate Projects, an initiative of Water Charity, to coordinate the funding of each project. According to the description on their Website, Water Charity aims to complete small but critically important water and sanitation projects working exclusively with Peace Corps Volunteers serving throughout the world. They mandate that each project present a complete solution to a problem, use appropriate technology, finish quickly, and cost no more than $500.

At Ruhunda, the project outfitted both the general and pediatric consultation rooms as well as the delivery room with sinks. Similarly at Musha, the consultation, pharmacy, surgery, and pediatric rooms received sinks and were connected to the local water source. From start to finish, the projects took on average two months to finish, and the positive results were visible immediately. A combined population of 22,167 people from the cities of Gishari, Munyiginya, and Ruhunda (all served by the Ruhunda Health Center) and 15,432 people within the Musha Health Center catchment area now receive a higher standard of care when they visit the local health center. In follow-up visits after the conclusion of construction, nurses and technicians applauded the improvements and noted an unexpected benefit from the water project – namely, their health had improved as well!

During the application process, Gerard Kaberuka, Titulaire of the Ruhunda Health Center, said, “Everyone knows that water is the source of life. If we receive water, then we receive life. Water will decrease disease prevalence and improve the quality of services offered at the center.” Now, thanks to Water Charity, water flows freely and life blooms in a healthy environment at Ruhunda and Musha.

Since first writing, several other projects to install internal running water in health centers have been organized and completed by Peace Corps Volunteers in conjunction with Water Charity. Jessica McGhie facilitated projects at three separate health centers in the northern Musanze District to install running water in the hospitalization, consultation, and pharmacy services at two centers and pipe in and treat the water at another. Similarly, Colleen Laurence has just completed her second project at the Murehe Health Post in Rwamagana District which installed sinks in the maternity, consultation, and laboratory services and connected them to the on-grounds water source. Her colleague in Rwamagana, Jenny Boyd, is currently working with the staff at Rubona Health Center to install water in their maternity, consultation, and laboratory services. The combined impact of these projects will affect the over 125,000 people who seek care at these health centers.

Cow Eyes, Intore Dances, and Searching for Milk - The Untold Story of Cows in Rwanda

A copper cloud of dust kicked up from the tires as our truck pulled itself up the steep hill towards the Muyumbu Health Center. Every few minutes, Anatole, our driver, would swerve to avoid the gaping potholes in the road and the yawning precipice which bordered it. Originally, these drives to rural health centers were a bit of a bother, but, by this point, I was unfazed by the constant jostling and, instead, used the time to catch up on sleep or debate politics with Charles. In this sense, the day was like any other.

It was a Wednesday morning, and we were running late as usual. I was dozing in the back seat as we zoomed over the steep terrain. Suddenly, the car lurched to a stop so quickly that my head banged into the front seat. As the dust settled, I rubbed my forehead and hastily scanned the perimeters of the truck. Did we run over something? A goat? A small child? “Charles, what happened?” I asked, still looking around. He was unresponsive, gazing out the window. “Charles, qu’est qui se passé?” I demanded, wondering if he had understood my harried question in English.

“Look.” That was all he said. I followed his gaze to an adjoining pasture which I hadn’t noticed in my frenzied search. There, over 30 long-horned, Ankole cows grazed in blissful ignorance of our white truck and its gawking onlookers. “We stopped for cows?!” I asked, not meaning to shriek in the process. The higher octave must have caught Charles’ attention because he then turned to me and proceeded to patiently explain the merits of each respective cow, noting their color, the size and shape of their horns, and their thickness and breadth. While this educational session didn’t calm me as Charles had perhaps hoped, it did serve another purpose, as a useful introduction to an element of Rwandan culture to which I previously hadn’t paid much heed before our drive-by cow-gazing that day.

This episode took place about three months ago, but since then I have been witness to several other moments when Rwandans displayed an almost undue reverence for cows. Instead of going to a country home or lake house for the weekend, I visit people’s pastures and cows; neighbors offered me gifts of cow butter when I first arrived in Rwamagana; and when lusty men try to woo me, they call me “cow eyes.” (Charming, right? You boys in the US could learn a few lessons from your African counterparts :P) In any case, through conversations with Charles and other Rwandan friends, I eventually came to appreciate their attitude towards cows and how it developed.

Long-horned cows or inka are woven into the fabric of Rwanda’s history, culture, and language even though they are actually an exotic species to region. Cows were introduced to the fertile Great Lakes region early on by traders and thrived in the environment, unique in Africa for its ability to host grazing livestock. Inevitably, cows became important fixtures of life in Rwanda, and their significance continues to this day. Not only do they provide milk and other dairy products critical for sustenance, but they also have symbolic importance in Rwandan culture. It’s difficult to escape them; cows are everywhere, physically and figuratively. When visiting a friend or family, you often sit down to share news over African tea (milk and tea with ginger); in dances performed at religious and cultural events, the women rhythmically sway and throw up their arms in a graceful V-shape, palms outward to mimic the slope and curve of cow horns; and, when I first arrived in Rwamagana, old women routinely asked me, “urushaka amata?” (Do you want milk?), sly smiles playing over their lips. I was always hesitant when responding to this question but, out of politesse, usually said yes. At this point, the women would always throw up their hands in a “Thanks be to God” salutation and call for their eldest son. I eventually figured out that “urushaka amata?” had a double meaning – are you looking for a husband? Needless to say, I don’t accept milk as often as I once did now.

Cows are also used as an informal currency in Rwandan culture, and the number of cows attributed to an individual is often used to gauge that person’s stature in the community. Once, towards the beginning of my service in Rwanda, Charles shyly admitted that he had over 20 cows at his pasture in Gisenyi and invited me to come visit them sometime. As I made more connections, I met more individuals who seemed similarly abashed while divulging the number of cows to their name. Eventually, I realized that these seemingly modest admissions of wealth were not modest at all, but a way to slyly establish their position and power in relation to others without overtly bragging.

In a culture which so glorifies cows and the stature they confer, it’s easy to see how this system could be manipulated to create and/or sustain a hierarchy. In fact, this is exactly what happened when Belgian colonialists assumed control of the Ruanda-Urundi region from the Germans in 1923 following the conclusion of World War I. Before Belgian’s began their governance, ethnic identity was a much more fluid concept. The Tutsi-Hutu distinction was not determined based upon physical appearance, as the Belgians preferred to believe and eventually instituted, but rather by the number of cows one possessed. The prevailing class system featured a minority Tutsi upper class and lower classes of Hutus and Tutsi commoners; however, one’s Tutsi-Hutu designation could change depending on the number of cows he or she acquired. For example, a Hutu pastoralist who attained a significant number of cattle would come to find himself and his family considered Tutsi.

The Germans and Belgians co-opted this economic system to create puppet rulers of the Tutsis, using Hamitic theory as its religious support. Individuals with 10 cows or more were labeled as Tutsi, issued an identity card, and educated through the public education system creating an educated Tutsi elite. Conversely, all those with 9 cows or less were labeled as Hutu and systematically disenfranchised by Belgian colonialists and the Tutsi class of rulers. In 1926, the Belgians also abolished the local posts of “Land Chief,” “Cattle Chief,” and “Military Chief” which further stripped Hutus of any local power they might have had over the land. Eventually, the labels which were originally economic in nature (akin to our labels of blue collar and white collar perhaps) became forever attached to physical traits.

It’s April - Genocide Memorial Month in Rwanda - and during this time of searching reflection and remembrance, I can’t help but wonder how the genocide would have been different or even if it would have occurred at all had these labels not been manipulated. Would the original economic divisions between Hutus and Tutsis have fomented into mass genocide as well or might they have found outlet in some of the socialist movements which gripped Africa in the wake of independence? But these “what if’s” are useless in retrospect. They do not heal the physical and mental wounds left by genocide nor do they address the very real issues of living and working in this developing country…of preventing this still very stratified society from shattering yet again.

Some believe that cows could still help this divided society even as many revile them as part of the problem. In 2006, President Kagame instituted a program to distribute cows to 250,000 of the poorest households at absolutely no cost. His hope and that of the Ministry of Agriculture and Animal Resources is that the cows will help support low-income households through milk and manure production. Heifer International also has an active presence in Rwanda and, since 2000, has been working to distribute cows throughout communities as part of their “Fight For Peace” initiative. When Heifer provides a family or household with a cow, they also educate those individuals about zero-grazing technology, better breeding practices, and conflict mediation techniques.

And yet while some, like Paul Kagame and Heifer, seek to increase Rwandans’ access to cows, others aim to limit it. It’s interesting to examine some of the compelling efforts at present to modernize Rwanda’s economy. The organization One Acre Fund is working in several districts to measure the actual worth of cows – the foodstuffs which they produce, their social value, and their monetary value at the time of sale versus their buying price. Though they are still in the process of conducting their evaluation in several districts, the results from some completed surveys reveal that, in general, “cows are not worth their fat.” The money which people use to buy, feed, and keep cows is not equivalent to the money and stature received in turn, especially for those small-scale and subsistence farmers who are only able to keep one or two cows at most. One Acre Fund argues that the money spent on cows would be better spent on education, health, and improving agricultural practices. One of my closest friends here, an English Education volunteer in Cyangugu, is working with Once Acre Fund’s campaign to educate Rwandans and help them to reevaluate the worth of their cows compared to health insurance, school fees, and nutritious food. It’s difficult work, she confessed to me, but she has faith that the “right” priorities will eventually prevail. Honestly, I’m a bit conflicted on the subject of livestock aid and am inclined towards the skepticism of One Acre Fund till proven differently.

Some of my language facilitators during training seemed similarly convinced that owning and obsessing over cows was a passé practice and that the importance of cows in Rwandan culture would fade as individuals confronted the necessities of modernization. Perhaps there is some merit to their claims, but, in speaking with my best friend, Janet, she seemed equally insistent that Rwandans would never fully free themselves of their ties to cows. I also asked Janet, who was recently engaged, whether she would accept money in lieu of cows at her dowry ceremony. She seemed affronted by the idea and immediately nixed any possibility thereof. According to her, when a family gives the bride’s family money in exchange for her hand, it is akin to selling her whereas if they give cows, they honor her and her family. Not being Rwandan, both practices seem terribly antiquated to me, but a small part of me (the anthropologist inside) wishes that Rwandans still practiced their previous custom in which a male member of the bride’s family took a spear and threw it as far as he could in the bride-groom’s pasture. According to tradition, all the cows between that male and the place where his spear landed would be apart of the dowry and herded from one pasture to another in an elaborate ceremony involving both families.

Alas such ceremonies are untenable now, but, at least for the time being, cows remain entrenched as both figurative and literal presences in Rwanda, and I hope this doesn’t change any time soon. Honestly, I’m not ready to wave goodbye to this cow-crazed culture just yet. I mean, where else can I use the insult I just learned? Kunnywa cy’inka. Roughly translated, “shit on your cows.”

A Different Battle Cry for Aid

Ensconced between folds of gently rolling hills in rural Rwanda lies the Ruhunda Health Center. This clinic is fairly typical by African standards. Cows graze in the adjoining pasture; mothers and tired children wait in negligibly clean, open air sitting areas; and staff members support operations in the maternity and general consultation wards by running buckets of water from a pump outside. It’s no Beth Israel or even Patient First in America, but it is suffices, meeting the needs of the 22,167 people whom it serves in the villages of Gishari, Munyiginya, and Ruhunda. To them, the clinic is merely an extension of their daily reality - poverty - and there is little which they can do to change that.

At Ruhunda, patients can access a range of services, including maternity, general consultation for children and adults, minor surgery, family planning, vaccination, and voluntary counseling and testing for HIV, among others. The center also runs a successful community health worker (CHW) program which trains Joe Schmo Rwandans to go into communities and conduct information sessions on a range of health topics.

A cursory review of the facilities and programs in place at Ruhunda would yield a positive review in the eyes of many a Rwandan health official. They would interpret the above description as evidence that Ruhunda is a self-sustaining health center. But they would be wrong. Oversight and planning of any kind is minimal. Reform is needed to improve the quality of care offered at Ruhunda and the countless health centers like it, but change won’t originate in top down Rwandan reform or by peasant uprising. Nor can we entirely rely on staff members who are too consumed by processing patients quickly and day-to-day survival to be the whistle blowers. There can be no doubt that the Ruhunda Health Center is in great need of additional reform and aid. The real question is what type of aid do they need most.

Different people would answer this question differently. Jeffrey Sachs might visit Ruhunda and proclaim the need for increased bed net distribution to allay the high prevalence of malaria, one of Ruhunda’s most frequently-treated afflictions. If Bono trekked out to Ruhunda, he might lobby for increased ARV monitoring and distribution as the keys to success. Scarlett Johansson would probably talk about malnutrition, kitchen garden demonstrations, and maybe a de-worming campaign. And me? What is my recipe for improvement at Ruhunda? An annual budget plan, drug requisition formulas, and a modem to update antivirus definitions on the center’s three out of four functioning computers. This, my friends, is the less sexy, but equally important aspect of development work.

Allow me to clarify. I say “sexy” because concepts like financial management and data processing do not pull at the heartstrings like AIDS orphans or school fees. Terms like these will never grab headlines and will forever struggle to grab the attention of most development workers. And yet these issues are equally as important and influence the quality of service for patients with illnesses like malaria, AIDS, and malnutrition. How can a health center with no annual budget in place afford to plan vaccination campaigns, buy or replace equipment, or even pay its staff? If the pharmacy is stocked out on mebendazole, how will they treat 5-year old Esperance who has contracted ascaris worm and subsequently suffers from malnutrition? Indeed, how can a center expect to achieve progress on any front if they fail to accurately record and analyze monthly data? This is what The Access Project and I, as a member of this organization, strive to improve each day.

Peace Corps assigned me to The Access Project – a project run out of Columbia University and The Earth Institute - in early December. In the beginning, I had only a vague idea of the organization and its goals. “They focus on macro-level management and infrastructure issues,” I told people, not really knowing what I meant by those words. But my friends seemed to buy it, nodding their heads knowingly in response. I bought into this hazy idea too, intrigued by the prospect of working on big picture issues after concentrating so heavily in health education on the ground in Mauritania.

After a few weeks in “the field” - traveling to remote health centers, interviewing staff members, and surveying record books and general conditions - the heretofore fuzzy objectives of The Access Project became increasingly defined. Suddenly, I was cross-checking health metrics data, brainstorming methods to streamline insurance information, and admonishing health center directors to purchase internet modems. In between, practicing English with every other Rwandan, of course. Suddenly, I understood how useful a business mentality could be if applied to the health system. Each of the centers I visited was functioning below its optimal capacity because of poor management and/or lack of obvious incentive to change its current practices. Believe it or not, the resources and money were there; all they needed was a little training, a push or, more likely, a shove in the right direction, and, most importantly, a change in mindset about their responsibility to provide the best care possible…which is where my work begins.

Each day, my fellow team members and I drive 30 minutes, 1 hour, 2 hours out to health centers tucked away in remote corners of the district. Our team of four consist of Anatole The Hun, our driver; Charles “The Strongarm” Ngirabatware, former politician and head of Access in the Rwamagana District; our resident number cruncher and erstwhile bookie, Pascal; and yours truly, the supposed tech guru (laughable, I know). You’ll have to pardon the nicknames; I like to pretend that our cadre is a highly-specialized team akin to the one amassed by Ethan Hunt in Mission Impossible, just without the marshal arts and bloodshed. It spices up long drives.

When we arrive at the health centers, the act ends, and we all set to work on our respective tasks. Pascal meets with the accountant and/or the insurance manager to discuss budget plans, review financial records, and check insurance enrollment. Charles discusses necessary improvements in infrastructure, planning and coordination, and human resources with the center director. He also steps in whenever Pascal or I need help applying pressure or, in my case, translation in one of our sectors. Officially, I split my time between data management and IT, but, more often than not, I end up teaching Excel 101, virus prevention, and how to use System Restore to rooms crammed with administrators.

Crowding around a beat up laptop, we wile away hours on end, experimenting with different formulas, plugging data into graphs, and reveling in the mystery that is file creation. On slow days, I start scanning all computers at one time and reward the staff member with the lowest number of infected files. They love to mock the person with the most computer viruses; it’s an interesting spin on peer pressure. In those sectors which record information electronically like Finance, Data, and Insurance, I stress weekly and quarterly data back-up. I never thought I’d derive as much pleasure from IT as I did from health education, but I do. The joy on Victoire’s face when she master’s graph creation in Excel is the same as Aminetou’s when she learns how to convince others not to use skin lightening cream.

Some might perceive my IT and data management lessons as a drop in the bucket in terms of effectiveness, but I know they’re not. I’ve seen the results – the spike in efficiency and tech comfort, the greater care afforded equipment at the center, the increased awareness and response to predominant health issues among health center staffs. This is the less sexy side of aid at work. If you’d like learn more about the efforts of The Access Project, you can read up on them at www.theaccessproject.com. I am also in the process of applying for a grant to install running water in the maternity and general consultation rooms at the Ruhunda Health Center. If you’d like to donate to my specific project, wait a week and then look for it at http://appropriateprojects.com.

Applying MBA practices to health care management is not a revolutionary thought in the world of international development. In the wake of massive, billion dollar aid programs which produce mediocre results, academics and practicians have long hailed the need for increased oversight and application of a business-like mentality to development work. “Reward results, not grandiose plans!” they cry. I get it. Now, I understand their arguments in a very real sense. Only, my battle cry is a bit different and, again, not as catchphrase-worthy. If I yelled, “Improved efficiency, monitoring, and management!” into the LiveAid crowd, I would probably get a few polite claps, some confused shrugs, and the overwhelming sound of crickets. But it’s true. We need to focus on the managerial and systemic roots of certain problems in order to improve the overall quality of care and response to those big name diseases. (In America too!)

Don’t misunderstand me. There is a place and need for both types of aid when well executed and successful. After all, we’re all playing on the same team, and Bono and Company, more so than I, have the ability to raise the profile of poverty in modern conscious. Likewise, Jeff Sachs and I both share the pipe dream that is the Millennium Development Goals even if I do have beef with its feasibility. And in the end, how can I begrudge Oprah and Angelina their orphans and bed nets?

Hollow Words: Gender Parity in Rwanda

Swinging back and forth in the wind, the fuzzy tennis ball taunted them from 15 feet above. Each girl craned her neck and stared disbelievingly at the ball hanging from the tree. Meanwhile, the coordinator explained their group objective, grinning mischievously at each girl who let out an exasperated snort in return. They were supposed to do what? Kiss the ball? What type of camp was this anyhow? But when the whistle was blown, each girl began to examine the situation and each other anew. How could they, a group of 12 teenage Rwandan girls, facilitate success of this mission? After a short consultation, they selected Peace, a petite girl with a short haircut and sassy fashion sense, to be their first guinea pig, slowly lifting her above their heads. She yelped and closed her eyes in mock terror while a handful of girls from below shouted instructions. Trying to rise out of her squat position in the air, Peace suddenly became airborne as the support from below disintegrated, and the girls crumbled into a heap of winces and limbs akimbo.

There was some grumbling. Peace stepped back warily as Grace, a taller teen of similar sassy disposition, stepped forward. This time, those girls who before had contributed half-heartedly with one hand on their hips, sturdily planted their feet and reached up with both hands to support the girl who hovered nearer and nearer the elusive tennis ball. They were so close. Peace shouted advice, and other girls relayed words of encouragement as they pushed forward and Grace lengthened her torso, reaching toward the ball. SMACK. Grace grinned and lifted her arms in triumph while the girls screamed excitedly below. And then they were all the on the ground again, but, this time, as victors. Their smiles broke their faces, and carefully constructed cool posteriors vanished. They had won.

To my mind, this was the turning point of Camp GLOW [Girls Leading Our World]. Randomly assembled girls from all over Rwanda - of different religions, ethnicities, backgrounds, and talents - began to dissolve previously constructed conceptions and view each other anew for their inherent potential and worth. They also conquered a physical representation of the challenges which they will very likely encounter in their journey to become leaders and confident, self-assured women. Throughout the weeklong camp facilitated by myself and other health volunteers, we worked with the 70+ girls to develop communication, team-building, goal-setting, and negotiation skills. We also sought to increase their knowledge with regards to entrepreneurship, career development, and various health topics like nutrition, hygiene, and HIV/AIDS.

It is difficult to quantitatively measure the success of projects like Camp GLOW. Sure, by its conclusion, 70+ girls knew how to properly use a condom and negotiate for its use. This knowledge is wonderful and not to be undervalued; however, I count success in other ways as well. I found it in the desire of one young girl to become a pilot; in the close camaraderie of girls of Hutu and Tutsi decent; in the marked change from whisper to strong, confident speech in one girl; and in the general realization that the glass ceiling in Rwanda needs shattering, and they are the group to do it.

Some might say that women have already broken through the glass ceiling in Rwanda, especially those who measure gender equality by legal rights and political representation. If women divorce their husbands in Rwanda, they are automatically entitled to 50% of their joint assets. This economic safety net provides women with some security and independence if they find themselves in an abusive relationship. But this assumes that all women are aware of this right, which is not always the case. Also, some of you may know that an awesome fifty-six percent of the Rwandan parliament is currently comprised of female MP’s, one of whom came to speak to the girls at Camp GLOW. Moreover, several women occupy positions of authority as cabinet members, and President Kagame has openly committed himself to the issue of girls and women’s empowerment in the country. But, as most women and men admit, this is mostly rhetoric aimed at making the country appear progressive for the benefit of foreign aid. In reality, the vast majority of women in Rwanda remain boxed in, stifled in speech, action, and dream.

Of course, the degree of burden and discrimination varies depending on several factors, including socio-economic class, education, age, location, and even religion. Women of little means in rural areas are taxed the most, charged with a multitude of responsibilities from general cooking, cleaning, and raising of children to production of marketable goods and support of extended family. Often, their husbands “contribute” by spending all available money on beer at the neighborhood bar. I don’t want to say that this situation is the rule, but is not the exception either. Unfortunately, this group of women often has the lowest level of education and is, thus, ill placed to argue for a change in their situation. There are associations and NGO’s aimed at helping and educating women about their legal rights, but they are often located in the larger cities where rural women do not know they exist and, in any case, rarely venture.

Women in urban areas are situated a bit differently. More often than not, they have a higher degree of education. Some have finished secondary school and may have continued their education at one of the colleges in Rwanda or in a neighboring country. At the very least, this grants them a bit more independence and authority in negotiating relationships in addition to aiding them in their employment search. But society does not will them to continue indefinitely in these ventures. Regardless of ambition or potential, marriage is the end goal in this hetero-normative society (homosexuality does not exist according to Rwandans). To be complete, you must have a husband or, conversely, a wife. I have only met a handful of women for whom marriage is not a box on some checklist. Sandrine, a close friend, is engaged to be married, but she has no illusions about her relationship with her fiancée, Patrick. “I know he’s frightened by my independence. He worries that I won’t cook for him once we marry. Maybe I won’t. But I love myself as much as I love him, and he knows that too.”

I stand in awe of Rwandan women most days – their physical and emotional strength. As I huff up a steep hill, they jog past me with a full jerry can on their heads, smiling and greeting the tired muzungu. Which is why I am so frustrated by the situation of most Rwandan women. Their brilliant strength and potential cut off at the knees by the legacies (and present-day realities) of gender-based violence, HIV/AIDS (3.6% women, 2.9% men in Rwanda), and general discrimination. They receive little to no actual encouragement despite the lip service which the government continues to give to the issue of gender parity. I am reminded of two Rwandan beer advertisements which I recently saw. One features a giant beer bottle surging up through concrete and the message, “Turbo King: The mark of a man.” Another advertisement features a suited Rwandan gentleman holding a beer with “The taste of la reussité (success)” next to him. Of course, the underlying message of both ads is that power and success are the domain of men, not women.

It is against this backdrop of such overt misogyny and favoritism that Rwandan women live and fight each day. The government is progressively loosening those ties which keep women strapped down, but it is happening without any concurrent shift in mindset in the general population. Of course, Camp GLOW is a step in the right direction. We must expand the bounds of what is possible for future generations. In this way, we will be able to change Rwandan society’s conception and valuation of women not only as mothers and wives, but also as innovators and sources of novel perspective and strength. However, it is not enough to cheerlead from the sidelines. If Rwanda truly desires parity between men and women, then they must engage and provide women with the tools to do so – employment centers, maternity leave, girl’s education campaigns centered on awareness-raising, college counseling, and halting harassment by teachers.

On the last night of camp, one of the girls in my group approached and asked to speak with me. Diana was one of the more reticent girls in my group, hesitant to offer her opinion and self-conscious about her English vocabulary and accent. But her smart eyes and slow, expansive smile belied a wisdom earned only through experience and the trials of emotion. Sheltering ourselves in a corner, she quickly launched into a mixed French and English account of her specific troubles. She revealed to me that she was an orphan of the genocide and now resided with a catholic nun who was supportive, but could not help her financially. While she had finished secondary school and scored well on exams, she feared her dream of becoming a doctor would never come to fruition because of her financial situation. She understood the necessity of working her way through college; however, she was unsure where to begin her employment search. “I do not want to do prostitution,” she emphasized, but opening her hands and gazing at me searchingly, I knew that the possibility had crossed her mind.

In that moment, I struggled to come up with some advice and/or comfort that would be relevant to her, something that wouldn’t sound hollow. All weeklong, we had discussed “Dreams, Goals, and the Tools to Achieve Them,” but when these grandiose words met reality, they seemed like empty shells – beautiful, but useless. Is this what we have to offer the young women of the world? Beautiful words? They deserve more, and we must do more than simply affirm their equality if we want them to become global citizens.

Umuganda

Holding the fraying rice sack wide open, we waited as the man with the shovel began scooping up rusty dirt and dumping it in. One-fifth... one-quarter…half. My partner and I looked at each other, sizing up our joint strength, and then nodded at the man to keep shoveling. Three-quarters. We put up our hands for him to stop and began to carry the weighty gunnysack to its destination – a primary school classroom whose floor was presently two feet below the doorstep. Our collective objective this morning was to prepare this classroom along with four others in similar half-constructed states. The plastic cut into our hands, and our shoes caught on rocks, as we hauled the sack the 100 feet or so to the classroom. But we made it eventually, heaving the dirt over a wall and then retreating back to pick up another load. He said something indecipherable in Kinyarwanda at that point. A blank look must have registered on my face because he just smiled, shook his head, and said “murakoze” (thank you). That, I understood.

I really felt like saying “thank you” to him though. In the course of that morning, I saw an entire community rally together with the sole objective of serving others and building their community. Young and old. Rich and poor. Politician, soldier, and civilian. Everyone came out, arriving early and carting their own supplies – torn rice sacks, split jugs and canisters, shovels and hoes. I saw women weighed down in front by sacks of dirt but balanced by another weight in back – a baby; I saw the mayor ditch his entourage for a shovel and dig in, literally, next to men in torn t-shirts and promotional caps; and I saw incarcerated prisoners, wearing their scarlet letter jumpsuits, living and working once again in a community. They had temporarily traded their chains for gunnysacks and tools so that they too could contribute and help further develop the country. Excited to finally work their muscles again, they readily dove into the work and, after settling in a bit, began to exchange hesitant smiles and conversation with us. They were just as curious about us muzungus as we were about them, and, for a while, it was kind of like a zoo, with each group scratching their heads and observing the other.

The random assemblage of persons collectively intent on one purpose is probably one of my favorite elements of Umuganda. Everyone – every man, woman, and child in Rwanda – participates in this monthly service ritual. On the last Saturday of each month, Umuganda shuts everything down from 8 in the morning until 12 while Rwandans stream out of their homes and into their communities, onto highways, and into construction sites. Sometimes, they pick up trash outside their homes and businesses. Other days, they participate in neighborhood projects, building schools, community spaces, and the like. This past Saturday, my 35 fellow stagieres and I along with the Peace Corps Training Staff joined community members from a Nyanza neighborhood to fill in the floors for five new classrooms at the local primary school. About 400 people participated for the entire time with hundreds of others stopping by for shorter intervals, lending a hand to our project before continuing with another.

Throughout the morning, scattered showers interrupted our work and forced us under the awning of the nearby school. As we waited for the storms to break and our muscles to recharge, we attempted to chat in Kinyarwanda while the Rwandans, amazed that we were trying to learn THEIR language, guffawed at our verbal missteps and then generously offered advice. More than once, I unintentionally emasculated a man referring to him as an akagabo or “a small man.” His friends would then crack up and throw punches at his shoulders as they praised me for my witticism. Meanwhile, I stood bewildered, wondering what the hell I had just done to this poor man. They tried to practice their English too. The prisoners who accepted our full sacks of dirt with a quiet “thank you” early on were soon shouting “Good Morning, Good Morning!” to every passerby by late morning.

Upon the conclusion of work, the mayor threw aside his shovel and took up his usual prop. The drizzling rain muffled his voice through the megaphone, but his message and intent were clear as he stood, staring out into the crowd. He tried to make eye contact with everyone as he thanked those assembled and urged them to remind those few non-participants that they too had a responsibility. Everyone is accountable to their community. After some more praise sprinkled with admonitions, the mayor surrendered the megaphone to the community. Now, the second objective of Umuganda – to build community cohesiveness and communicate information - would officially begin. The meeting didn’t last much longer because people had begun to resemble sodden cats, but a few community members shared brief updates and aired concerns.

Even now, almost a week after our scant hours of gritty work, I’m still a bit in awe at the collective spirit and mission of Umuganda. Though we, as Americans, are often more than happy to devote time and energy to service each month and, for some, every day of each week, it’s different somehow. I can’t really put my finger on why exactly. Perhaps it’s the universality of their commitment that seems novel and refreshing. Or maybe it’s the fact that they don’t seem to perceive Umuganda as mandatory community service but more so as a civic responsibility.

Honestly, I’m curious whether a program like Umuganda would even work in the States. Granted, groups of people frequently gather to pick up trash and/or beautify areas in the US, especially for special events like Earth Day. However, I wonder if Americans would view something like Umuganda as infringement on their time and liberty, as a requirement rather than an opportunity. To those friends of mine back home who study service learning and/or examine the willingness of our generation to serve, I present to you another vision of service, one which seems very nearly wholly altruistic. Though introduced through a nationwide initiative, it is not mandatory and takes shape in the autonomous acts of individuals and communities. I wonder, is it possible to mold future generations of Americans to this concept?

Maybe yes, maybe no. In visiting other countries, I have come to better understand and appreciate the unique individualism which Americans often cultivate in their personhood and which may or may not lend itself to an Umuganda-like program in the States. Unfortunately, the greater world often associates this individualism with cocky moves and international missteps by certain Administrations, but I like to think that we, as volunteers, expose them to a different kind of individualism.

A few days ago, I was walking home after language class when the skies opened up and flooded the Nyanza countryside with blankets of rain. Every Rwandan took their cue and scuttled for the nearest shelter. Me, I decided to keep on strolling, savoring one of the few moments when I could actually embrace my Otherness. Maybe it was my rugged American individualism which kept me out there as my shoes slid every which way and my already loose pants began to sag. Or perhaps it was the two songs on repeat in my head – “Storms in Africa” by Enya and Carla Bruni’s “Plus Beau de Quartier.” As much as I’d like to believe that the Rwandans who peered curiously at me from windows and doorways saw my rainy day promenade as an act of individualism, I know they probably just chalked the incident up to another crazy muzungu move. For some reason, I’m okay with that label. As Carla Bruni would say, “Regardez moi, Je suis la plus folle de Quartier.”