I’m sure you’ve been in that situation where you have a guest over who has really been a pleasure, but they just won’t leave. Maybe you have work or school in the morning or you’re just dead tired and want some time alone. You can drop subtle hints – yawn or talk about how early you have to get up the next day. You can say that the kids are asleep or express concern about the guest’s drive home. More often than not, the guest is courteous enough to understand, thanks you for the invite and goes on their merry way home until you meet again. In that sense, there is a way to deal with those people who you love and care about when they just won’t seem to leave.

Electoral Commission of Uganda

But when it comes to national leaders, it’s unfortunately just not that easy. In post-colonial African history, there are far too many examples of autocratic leaders who will stay in power for decades despite great dissatisfaction from the people. They’re infamous – Mobutu (Zaire), Gaddafi (Libya), Mubarak (Egypt), Mugabe (Zimbabwe), Al-Bashir (Sudan). Some of these leaders were brought in by democratic means, while others took power via coup d’état. In Uganda, Yoweri Museveni has been president since 1986 – he is now going on his 25th year. He recently won a much-disputed election for another term against an opposition leader who had great support… and yet the voting results were fishily lopsided in the incumbent’s favor.

Peace, Stability, and Security! Museveni's campaign ads all over town

Uganda suffered greatly under 2 ruthless leaders post-independence: Idi Aminand Milton Obote. The country was in shambles, and safety was never a guarantee. It is estimated that a half-million Ugandans perished under their regimes. When Museveni took power, he was a welcome change. He guided the country in the right direction, boosted the economy, emphasized education, and has kept the country safe and war-free. But after a couple terms, Ugandans began to question his ways. He himself changed the constitutional law that restricted presidents to two terms only. Corruption scandals emerge weekly from his administration, some of which are downright shameful. For example, in the paper I’ve read about how the money provided by the Global Fund to fight HIV/AIDS, TB, and Malaria to Uganda has disappeared. It was supposed to be used for medications for the destitute. The same goes for loans from the World Bank. And now, after Museveni questionably was elected to a fourth term, people are saying that he is lying about his age so he’ll be under 75 for the next election, which is one of the eligibility requirements.

Besigye, the opposition leader whose election defeat to Museveni caused riots

I told my friend Patrick that Obama makes only $400,000 a year, and he leads the most powerful nation on Earth. I said that here, the presidents are probably making $400,000 a week. He looked at me sternly, and then said, “No. Every second!” and laughed as he said it. I looked at him alarmed and he replied, “Well what can we do? You just have to keep living. Focus on your own life and family.” It makes sense that if you burdened yourself with anger and constant disbelief, you would go crazy. And so, you just laugh it off. When I raised a similar conversation with Rashida, a doctor at the hospital, she put down her file and chatted away for 10 minutes about Museveni, getting visibly more and more flustered before she abruptly stopped and said that this is why she needed to just absorb herself in her work. Voting, according to her, was a waste of time and energy. “It’s going to be rigged, anyways.”

Too many Ugandans have experienced war and instability. Safety is a big deal. If Museveni wants to remain in power but at least continues to keep the nation safe, so be it. Many have told me that they would rather be safe and impoverished rather than improve their standard of living but constantly live in fear. But no one has expressed hope that both of those things can exist together. Some of my co-workers have said that unless revolutions like those of North Africa sweep Uganda, there doesn’t seem to be a way to send home the president who in their minds has overstayed his welcome.

Spraying pesticides like clockwork each evening

Despite the fact that HIV/AIDS seems to be the largest focus of public health efforts in Africa, malaria continues to be a huge, constant threat. Kampala is a city of hills, so people who live at the top of the hills tend not to suffer from any mosquito problems. We, on the other hand, live next to a swamp, which is basically a giant breeding ground for the pests. As a result, I sleep in a bed that’s surrounded by a bed net, take daily prophylaxis, and spray any exposed skin after dark. We’ve done some indoor residual spraying as well with an aptly named bug spray called Doom. If that wasn’t enough, the apartment I live in has a unique “tradition” every night. An employee, with what looks like a giant metal leaf blower on his shoulder, runs around the entire building like a madman, unleashing some type of mosquito pesticide into the air. For a while, it just looks like fog has descended upon our building. But then, the fumes creep through the non-airtight windows and doors, and all of a sudden it feels like we’re being gassed in our own homes. Sometimes we’re just innocently walking around the grounds when we hear the unmistakable rev of the malaria man’s machine. Preferring to not get doused in chemicals, we, too, then run to our rooms and hold our breaths. It sometimes feels like we’re in one of those horror movies where we’re pounding at the door hoping in vain that someone is there to let us in so we don’t suffocate in pesticides. In the end, though, we rather not get malaria, so it really is appreciated.

And here he comes...

When you look at donor funding, far less financial resources are allocated to malaria as compared to HIV/AIDS. Malaria is a huge burden on daily work life and the economy, and the entire population of Uganda is at a real threat of contracting it. Since it is endemic, some people get it multiple times a year. However, it is important to keep in mind that malaria is far, far easier and cheaper to treat. A rapid malaria test costs 2000 shillings (less than $1), and testing positive isn’t shrouded in the stigma that can accompany HIV. Treatment takes only a few days. Still, it’s interesting that some simply assume that they have malaria without getting tested, and they opt to treat themselves for it anyways. Whereas our default health issue back home is usually self-diagnosed as a cough/cold, the default here seems to be malaria. Others, who likely have malaria, don’t bother to get tested or treated. It’s so common that it’s often just met with apathy. When one of the doctors at the hospital had malaria a few weeks ago, he turned to me and said nonchalantly, “Let’s see as many patients as we can before the next set of fevers and chills sets in.” So far, none of us have come down with anything serious, so let’s keep our fingers crossed.

Oruzogo gorillas, Bwindi NP

There are only 754 mountain gorillas in the world. They are listed as “critically endangered” which is the last classification before official extinction. These gorillas live in only two sites in the world – one is the Virunga volcanic chain which runs into DRC, Uganda, and Rwanda (where I climbed a volcano a few weeks back). The other is Bwindi Impenetrable Forest, which lies wholly within Uganda. To see the gorillas, one has to book a gorilla permit through the national wildlife authority of the country often months in advance, because only a small number of humans are allowed to track the gorillas daily. In fact, the Rwanda permits are sold out until September.  The Uganda permits seemed unavailable for June and July. So would we have to go to the Congo to see gorillas?

Young gorilla, Bwindi

I still suffer mild trauma from when my older brother took me to see the movie Congo when I was about 8 years old. Still, if this was the only option to see the gorillas, then we’d head over there. The only issue was that, as you well know, the Congo has had a raging war going on for the last several years. It happens to be concentrated in the northeast of the region, which is exactly where the mountain gorilla park is located. Optimistically, we were thinking it’s a big region – we might be ok. Let’s do some research. So we did, and we found that in January of this year, 3 park rangers and 5 soldiers were tragically killed when a grenade was hurled by guerrillas at their vehicle, which was traveling along a tourist road within the park. But in Congo, where 6 months time is equivalent to a decade in other places since things change so rapidly, we thought perhaps things have calmed down by now. And then we saw that another park ranger was killed… two weeks ago. Attacks were happening in the park! The guerillas were largely members of FDLR, a Hutu rebel group. And while I’m sure a part of the park is safe and trackers still go to see gorillas, it was alarming that a national park needs UN peacekeepers because guerrillas are hiding in its forests.

Snack time

And it’s not just the people who are in danger from the guerillas… the gorillas are also impacted by the guerrillas. Three years ago, National Geographic ran a front page story titled, “Who Killed the Mountain Gorillas?” after 7 of them were found dead in the Congo park. Poachers are another threat – last week, one gorilla was speared and killed in Bwindi itself.

But then by some miracle, an agency found us 2 permits for Bwindi in Uganda! So Anita and I packed up, and traveled the 10 hours to the forest in western Uganda. The road to the park unexpectedly went right through Queen Elizabeth National Park, so we got a free safari each way – elephants, antelope, buffalo, and more. Of course, our vehicle broke down a couple times and also had a flat tire, but we still made it for our permit appointment time. When we started hiking, we were still only 0.5 km from the Congo border, but it was the less volatile part, far from the Virungas. It absolutely poured right as we started the hike and didn’t stop until we ended. We went to see the Oruzogo gorilla group, which was very recently habituated and opened to viewing by trackers. In fact, we were only the second group to ever see these gorillas (or have the gorillas see humans), which I thought was pretty cool.

Staredown

In total, we saw about 14 of the 22 members of the family, including 2 babies, the silverback male, and the blackback male who will take over for the silverback as leader at some point in the future. They were massive, literally taking down small trees with a swat of their hand. When they moved down the mountainside, vegetation just collapsed underneath them. Finding them was an adventure in itself in the rain. I can’t tell you how many times I just slid and fell up and down the muddy mountainside. At some points, the ground was covered so thick in jungle vines that I was literally 2 feet off the actually ground. Once the trail disappeared, the guide would have to use his machete to make small clearings for us to pass. We couldn’t spend too much time with the gorillas because their similar DNA makeup makes them susceptible to human disease, but the whole trip was certainly worth it.

Mountain gorilla tracking

HIV/AIDS home-based care

Every Wednesday, the HIV/AIDS unit at Mengo Hospital partakes in home-based care for patients who have agreed to it or have requested it. We go as a team of 4 or 5 to patients’ homes all around Kampala city and the surrounding areas. Given the stop-your-engine type of traffic and the large distances between homes, it can be a long, draining day, but nonetheless incredibly fulfilling. Doing these visits helps us better understand the living circumstances of the patient, such as available resources and support networks. A patient may be sleeping on a mattress on a floor of a mud brick home all alone or be staying in nice quarters surrounded by family members at all times. The visits also let us check the physical state of some of the most critically ill, ensuring that they do not delay in getting treatment. For the patients, it is refreshing to be able to stay at home instead of commuting all the way to the hospital. It saves them the time, energy, and hassle of transport. It also shows them that the medical staff truly cares about them. I’ve seen how important it is to have that patient connection in a non-medical setting. Home-based care visits feel like old-fashioned house calls, and it’s something I now have a greater appreciation for.

Meds on wheels

Finding the homes is a challenge in itself. We come from a land where we take addresses for granted, but here in Uganda, you’re lucky if your street has a name and your house has a number. The patient files will ask for landmarks, instead. So we’ll search for so-and-so primary school or such-and-such bakery or fried cassava stand. When we eventuallyfind people who can take us to our clients, we walk into the homes with a suitcase full of medical supplies. Often, seeing the patient just involves drug refills or new prescriptions, or taking vitals plus a quick physical exam. Sometimes it can involve giving IV fluids. The bag is usually hung from a nail hammered into the dirt wall of the patient’s home, and we train the family members on when and how to switch the bags when they are completed if there isn’t a community health worker in their neighborhood already. Home-based care has also been important for the families taking care of patient. They may need more counseling and support than the patient themselves, since they have taken on the responsibility for that person’s life.

Finding the homes can be a challenge when there's no address...

Last week, we had a patient who the hospital had lost track of for months because she had stopped coming in for her regular appointments. For one reason or another, she decided to abandon her HIV medications entirely. When we finally saw this patient, she was skeletal, and her voice was just barely audible. Patients can easily lose hope in their treatment or feel like they are too great a burden on their already financially-constrained families. I’ve seen pictures of patients pre-AIDS hanging around the house, and physically, some are a shadow of their former selves. But feelings of stress and depression can be devastating to one’s health, lowering immunity in the individual who is already immune-compromised. That’s why it is so important to promote positive attitudes for the patient and family members alike and enforce a spirit of hopefulness and optimism. Making these people feel at home when they come to the hospital is a great thing, but deciding to actually go to their homes is entirely different.

Here are a few stories from the hospital to highlight some of the most challenging aspects of living with and treating HIV/AIDS in a resource-limited setting. To preserve confidentiality of the patients, certain details have been omitted and certain others have been modified.

Mengo Hospital HIV/AIDS Clinic

Patient A: The man sat patiently on the treatment room bed as his chemotherapy was being administered. He was HIV positive, but along with that, he had diabetes, hypertension, cancer, and tuberculosis. He looked distinguished in his suit and tie. The patients at the hospital span Ugandan socioeconomic strata, but the majority fall in the lower/lowest brackets. Still, individuals such as this one – educated, wealthy, well-informed – go to show that the disease really does not discriminate. HIV is not simply a disease of poverty, as it is often branded in sub-Saharan Africa. Additionally, the HIV cases we see are never just HIV. Here is an individual with not 1 but 4 serious accompanying co-morbidities. HIV is not easy to manage, and having all of the additional maladies certainly does not make things easier (for both the treatment staff and of course the patient).

TB medications and counseling in the TB tent

Patient B: HIV can be transmitted from mother to child during pregnancy/birth/breastfeeding, although there is a huge push for PMTCT in all countries (Prevention of Mother To Child Transmission). A young woman from the village came in, sobbing. She never took an HIV test and delivered her children at home. She was persuaded by her church to get tested and recently found out she was HIV+… which meant that her husband was also positive… and that he had been with other women… and that her son may have also been positive since birth. In a culture that values a large number of offspring, she felt obliged to produce children. She was already 3 months pregnant with her next child, not having known her status until today. Had she known, she said she would not have had any more children. She says that her husband refuses to test for HIV, and she was unwilling to disclose her status to him. She said with certainty that if he found out her status, he would leave her, despite the fact that he was the one who likely passed the virus to her. In one day, everything in her life was flipped upside down, and all that she had assumed about her relationships and family crumbled around her.

Tuberculosis tent at Mengo

Patient C: A Congolese man with obvious AIDS-related wasting slumped in his seat facing us. His cheeks were craters and the bony structures of his skull were unusually protruded. He weighed less than 80 pounds. A person’s CD4 count is an indicator of general immunity, and technically, AIDS is diagnosed when the CD4 count dips below 200. His CD4 count stood at 6. Additionally, he had cryptococcal meningitis, an AIDS-associated fungal infection of the brain that would require him to take a certain medication for life, along with all the HIV-specific medications he would be prescribed. He was asked why he waited to come for treatment, and it was a barrage of the same reasons we hear each day from many of the newcomers to the hospital. I can’t afford it. I thought I would get better. I was fearful. I had no transport. I was needed at home. Certainly, there are success stories, and I will capture those, too. One can only hope that this man will be one of them.

It is hard to wrap my head around the complexity of these cases – the economics, social structure, culture, behavior, and biology which produces what I’ve seen. This is just a glimpse into the lives of some who visit the HIV/AIDS wing of the hospital, but these are not uncommon stories for Kampala, Uganda, and much of HIV-affected Africa.

The Mengos - Jacob, Karrin, and me

There are 8 of us working under the Global Health Fellows Program this summer, and we are divided over 3 worksites around Kampala. The sites are TASO (The AIDS Support Organization), Meeting Point, and Mengo Hospital. Each of us has an individual role assigned by GHFP. I’m the HIV Care and Treatment Intern at Mengo Hospital. Jacob (HIV Counseling and Testing) and Karrin (Orphans and Vulnerable Children) work at the same site as me, and so we collectively refer to ourselves as the Mengos. Every morning we take a four-step commute that involves a lot of walking and a lot of taking the matatus (large vans which are the local form of public transport) to get to work. By 9 AM, the HIV section is already buzzing and patients have filed in by the throngs into the waiting area.

We descend into this madness for a ride to work each day

Mengo Hospital is Uganda’s oldest hospital, founded in 1897 by Sir Albert Cook, a physician-missionary from Britain at a time when Uganda was part of British East Africa. It is a full-fledged hospital with all units, but the three of us specifically work in the HIV/AIDS wing. This is our 4th week at work, and I have been under the mentorship of Dr. Vincent, one of the doctors who works at the site. Each day is routine in the sense that we start by working in the treatment room where the critical HIV patients are admitted. Then we work in checkup rooms where we see HIV positive individuals who are coming in for their regular appointments. But aside from that, each day is far from routine in what I am seeing, doing, and learning. Vincent gives me daily homework assignments, so I go home and read up on whatever he thinks I should learn about – the HIV drugs, TB treatment, toxoplasmosis, Kaposi’s sarcoma, etc.- and present to him the next day.

Mengo treats thousands of HIV+ patients

It took me a very short period of time to see and understand how complicated HIV management was. I started by learning about the medications and I saw the complexities right then when deciding the right drugs to prescribe to positive patients. Are they pregnant? Do they have TB? Are they pregnant and have TB? Are they breastfeeding? What’s their CD4 count? Do they have malaria? Are they experiencing side effects? Have they become resistant to the drugs? Then there are the social questions. Are they married? Separated? Do they have kids? Do they want kids? Have the kids been tested? Has the spouse been tested? What is the level of education? Are they employed? Do they live far away? What additional risk factors are present in their lives? And then you combine the two sides – the medical and the social side – and I hear the most ridiculous stories each day (I’ll share some with you soon).

With Nurse Lillian and Dr. Rashida

There have been many eye-opening moments/days, and it literally started within the first hour I was there. We were getting oriented to our workplace, and Dr. Vincent pulled me aside to show me a newly admitted HIV positive patient. She was an advanced case – cancerous lesions on her body, fungal growth in her mouth, and suffering from HIV wasting syndrome. Her eyes were sunken in and her clavicles were popping out of her body. Little did I know that these types of presentations would become a normal daily occurrence. In the US, we would never see patients who present this late. But miraculously, the hospital and its staff are able to get these patients back on their feet. So what exactly do I do at Mengo? It really covers a lot of ground. I assist the doctors in any way possible – patient histories, physical exams, prescriptions, referrals, surgical procedures, and counseling. With the patients from the Congo, I serve as a French translator. We lead outreach to local high schools and also carry out home-based HIV/AIDS care. The doctors are constantly teaching me what they feel is of importance. It’s been amazing so far. Details on everything to come soon.

On Thursday, we had a meeting with the health coordinator at USAID Uganda. The office is located within the American embassy in Kampala. It was basically a walled fortress. Technically, it’s American soil, and honestly, you wouldn’t know where you were unless you crossed the cement/barb wired fence. The 8 of us had to go through about 5 security checks within a distance of probably 200 feet. Then again, I think they really have a right to be cautious. In 1998, the US embassies in Nairobi, Kenya and Dar es Salaam, Tanzania were simultaneously victims of Al-Qaeda terrorist attacks.

Downtown Kampala. No space, no problem.

We met with Dan, who is a program manager at USAID Uganda and had an engaging 2 hour q and a session with him. Uganda is among the top 20 recipient countries of assistance from USAID, receiving some $200 million dollars annually (#1 recipient is Afghanistan, #2 is Pakistan, #3 is Haiti). There are four main aims for the money’s use in Uganda: democracy and governance, economic growth, health/education/HIV, and security enhancement in the poor western region. When it comes to issues in the developing world, Americans often wonder, “What can I do to help?”.  You may/may not know, but your tax dollars already do so much abroad through the agencies of the federal government, including USAID. In fact, anytime you see a USAID logo on a building or on medications or on mosquito nets, it will always say “From the American people.” Dan said that in particular, George W. Bush’s PEPFAR (President’s Emergency Plan for AIDS Relief) literally changed the course of the country and has saved tens of thousands of lives. As much slack as Bush has gotten, Ugandans view him completely differently for his commitment to HIV/AIDS in Africa.

Uganda

While there has been a lot of success, Dan still talked about some of the issues that they face. Foreign assistance is unpredictable – Ugandans are relying on money that hasn’t/won’t be a steady stream, especially in an economic downturn. Also, it is the U.S. government that ultimately decides where the funds are to be allocated in recipient countries. The earmarking is usually on target, but Dan says that is not always a case. “For example, sometimes it’s like someone giving you trousers when you don’t want trousers. You really need a shirt. We may be in need of funds for HIV education but instead the funds are allocated for HIV treatment,” he said. Still, that’s an imperfect process that they’re working on perfecting. All in all, it was a super informative session. In light of all the information we received at the meeting, I realize I should introduce some basics of Uganda as a nation:

Nickname: Pearl of Africa

National borders: Rwanda, Democratic Republic of the Congo, Tanzania, Kenya, Sudan

Water: landlocked, but has Lake Victoria, the world’s 2^nd largest freshwater lake (from which you can easily contract schistosomiasis, a parasitic disease transmitted by snails, so don’t swim in it!) and the source of the Nile River

Population: home to about 35 million people and the 2^nd highest birth rate in the world. It’s a young population, with the median age at 15. The life expectance is only 53 years. The HIV prevalence is 6.5% and there are 1.2 million who are infected.

Politics: Idi Amin, infamously known as the “wild man of Africa” ruled as a dictator for nearly a decade followed by an almost equally ruthless leader, Milton Obote. The current president, Yoweri Museveni, has been in power for 25 years and doesn’t show signs of leaving, but he has greatly brought the country forward from where it was.

Religion: More than 85% Christian. It is certainly a religious society. People pray before car rides, before the work day, after the work day, before all meals, etc. One of the first (sometimes the very first) questions someone will ask will be “What is your religion?”

Ethnic groups: The Buganda are the largest tribe, and they dominate the central region of the country, including Kampala, where I live and work. While they seem to speak great English since they’re a former British colony, the locals also speak Luganda. So basically, the Bugandans speak Luganda in Uganda.

Parc National des Volcans

Parc National des Volcans(Volcanoes National Park) is located around the Uganda/Rwanda/DRC border. It contains part of the Virungas, a volcanic chain of mountains in the region. The park rangers said that the volcanoes have been dormant for two thousand years, but 8 years ago, one of them exploded on the Congo side and half buried the city of Goma in a fashion similar to Pompeii. Comforting. Worries aside, the park reminded me of something straight out of Jurassic Park. The stereotypical towering volcanoes with their flat tops surrounded us on all sides. Odd animals would cry out randomly, and birds with pterodactyl-like wingspans hovered above. There were earthworms the size of snakes along with poisonous plants, which if touched would cause a burning rash. It was hard to avoid them completely, but luckily, there was always a neighboring plant which conveniently provided a healing sap. Problem solved. The hilly rural areas surrounding the park were covered from top to bottom with a patchwork of different crops, either terraced or somehow growing horizontally from the hillsides. And although this was technically “rural” Rwanda, it was crowded to a degree. That came as no surprise when we found out that Rwanda is the most densely populated country on the continent.

Bisoke Volcano summit and Crater Lake

To get to the top of the volcano, Bisoke, we had to basically go through an entire rainforest. Although the park rangers claimed that this was the dry season, both going up and coming down resembled more-or-less a muddy, narrow slip-n-slide. We all fell multiple times. The top was incredible, though. The volcano caldera had become a lake over the years. However, they told us not to swim in it because potentially deadly gases trapped underneath could bubble out at a moment’s notice.  Considering the fact that Chicago is as flat as a pancake, I don’t consider myself much of a mountain climber, although I do find it enjoyable. I also realized that strangely enough, I have climbed four mountains and they have all been in Africa (Mount Sinai, Mount Kilimanjaro, and Table Mountain).

Karrin and I climbed with a Swiss man who worked for the Red Cross in Rwanda. We were telling him our shock at how well the people and the country seemed to have moved forward from the genocide. Our driver who brought us to the park himself was saying that he holds no negative feelings and that all is well now, despite the fact that he lost all but 2 family members and found his mother and sister dead in a latrine in 1994. The Red Cross worker begged to differ. He said that at a cursory glance, everything seems awesome in Rwanda – the shining star of East Africa. However, after staying there for months, he talked about this indescribable heaviness he noticed that surrounded the people. The weight of one million dead doesn’t just disappear. Seventeen years later, the society is still suffering. Families are still broken, orphans abound, and the trauma from the events has manifested in severe mental issues for the majority of the population. Not one person in the country was untouched by it.

And the clouds come in...

Another problem he mentioned was that the government has branded the genocide as a “Tutsi genocide”. I could believe that – every memorial and sign we saw referred to it as the genocide of the Tutsis. However, he was saying that just as many Hutus were killed (although given that Hutus were 85% of the population, the proportion of Hutu loss was smaller), either for helping the wrong people or marrying into the wrong tribe or befriending Tutsis. Hutus are socially then not allowed to mourn given that it was not “their” genocide, so they are all suffering in silence. The Tutsis who survived endured much difficulty also because people questioned whether they were Tutsis at all since they were among the very few who survived. The Tutsis also questioned themselves – “Pourquoi j’ai survecu?” – Why did I survive?

When I was talking to him during the climb, I at one point said the word Tutsi a bit louder than the hushed whisper we were talking in (for no one in Rwanda really wants to talk about the genocide/tribes/etc so we had to keep our voices down), and we both realized the mistake I had made. No tribalism. It’s interesting that neighboring Tanzania has been free from tribal conflict since independence thanks to its founding president, Julius Nyerere, who turned the nation to socialism. No tribalism in Rwanda came at a completely different cost.

Rwandan tribal identification card

I was 15 when I first learned about the Rwandan genocide. I’ll never forget that moment – I had to do a reading assignment for my world history class with Mr. Williams, and I picked a book off his list titled “We Wish to Inform You that Tomorrow We Will Be Killed With Our Families.” It consisted of detailed stories from Rwandans and the surrounding history of the genocide. I remember being absolutely stunned by it. How come I had never heard of this event? With all the Holocaust literature and history we had been learning, I had just assumed that “never again” really had meant never again. And yet, here I was, reading about something so horrific that had happened in my own lifetime, a mere ten years before I picked up the book.

Garden memorial. Within 3 months (from 4/6/1994), one million dead.

There are genocide memorials in essentially every district within Rwanda. Karrin and I visited two which were about 45 minutes outside of Kigali. Both were churches – Nyamata and Ntarama. 1994 was not the first time Tutsis had been marked for ethnic wipeout. The Belgians divided Rwanda into arbitrary tribes based on racist anthropological measures, and once the colonial power left, the Hutu majority began to target the appointed privileged Tutsi minority. “Cinquant-neuf” was something I heard repeatedly from people – it  refers to 1959 in French, and it marks the first large-scale massacres of Tutsis. 1992 was another year that marked the same. The government even forced the Tutsis to relocate to a part of Rwanda where tsetse flies were prevalent. That way, the Tutsis would die of African sleeping sickness without anyone knowing that the deaths were intentional. The Tutsis sought refuge in Catholic churches during times of turmoil, and they were protected. But in 1994, the situation changed somehow. Church leaders sold the refuge-seekers to the genocidaires, and thousands perished. The nation was almost entirely Catholic before 1994, but the numbers have shifted since. People converted after understandably losing faith in church leaders and in the church itself.

Genocide memorial at a Catholic church

The rows and rows of pews inside the churches were completely covered in piles of red- stained clothes. The ceiling was riddled with bullet holes, and large breaks in the walls marked grenade attacks. There was one section where you went underground to find shelves stacked high with skulls, femurs, and pelvic bones. I tried to tell myself that the bones were fake, but that was short-lived after noticing the bullet holes or the long machete strikes that marred them all. There were heaps of rosaries and kids shoes and government-issued identity cards which marked one’s tribe. One wall was blotted with round blood stains – apparently the Interahamwe (the civilian Hutu army) held children upside down and hurled them against the bricks inside the church. It was sickening. Women and children were especially targeted because they wanted to prevent the existence of any further generations of Tutsis. Outside, there were mass graves where about 45,000 bodies lay.

Site of the Hotel Rwanda story, 1994

The Kigali Memorial Center located within the city was a comprehensive museum of colonial Rwanda, the events of the genocide, and the aftermath. It showed how the UN peacekeepers did nothing, when all it would have taken was about 5,000 of them to prevent one million deaths committed largely by ragtag street gangs armed with primitive weapons. The museum was covered floor to ceiling with pictures. And to make it all the more real, they described in detail some children who perished. Their name, their favorite toy, their best friend, and how they were killed. A banner hung above the display with the quote of a victim: “If you knew me and if you knew yourself, you would not kill me.” They had another quote that stated, “When they said ‘never again’ after the Holocaust, was it meant for some people and not for others?” A Nigerian man who was visiting the memorial muttered, “Human beings are forgetful animals.” Considering that after WWII there was still Cambodia, Rwanda, Bosnia, Sudan, etc, the man certainly had a point. Countries have dealt differently in the aftermath of such disasters. South Africa established the Truth and Reconciliation committees. Rwanda has used its village gakaka (pronounced ga-cha-cha) meetings, traditionally for settling small disputes, to bring reconciliation among the Rwandans. Uganda, despite the hundreds of thousands who died under Idi Amin’s rule, has not memorialized or formally reconciled its past and has simply moved forward and brushed that history aside.

We also made a stop at Hotel des Milles Collines, where the events depicted in the movie Hotel Rwanda actually unfolded in 1994. People were drinking martinis along the pool at Milles Collines. School children were playing in the fields nearby the church memorials. Eerie in some ways, but it was positive to see that life was moving along in Rwanda.

Thursday was a national holiday in Uganda – Hero’s Day. As a result, we had a super long weekend. Karrin, a fellow intern, and I decided to spend it in the neighboring country of Rwanda. We took a 9 hour bus ride from Kampala.  It was certainly a boisterous journey, with people yelling basically for the entirety of the trip, trying to outdo the blasting R&B music, the rumbles of the overworked engine, and the speeches of evangelists preaching from their pocket bibles to all on board. But we made it, safe and sound.

Rural Rwanda outside of Kigali

We landed in Kigali, the largest city and the capital of the small country. I was struck first and foremost by the cleanliness and organization of the city – a far cry from Kampala. Apparently, there are huge fines just for littering à la Singapore. The Rwandan motorcycle taxis, which in Uganda are often described as death traps, are driven by individuals who actually wear helmets, force their passengers to wear helmets, and keenly obey speed laws. Everything was orderly, although quite expensive for East African and even American standards. After the genocide, French was officially replaced by English as the national language, but the majority of people we bumped into were still more comfortable with French. I’ve never been so thankful for finishing that undergrad minor. From what I understood from the Rwandans, this was partially due to the role the French played in the 1994 genocide and partially to oppose the country’s colonial past. Many also spoke or understood Swahili, so we were able to communicate in one way or another, often having to triangulate languages. 

Land of 1000 hills - dotted with crop squares

The President, Paul Kagame, is trying hard to remake the image of the country, which is largely infamous for just one thing.  Many applaud his efforts to move Rwanda forward. He is trying to eliminate tribalization, the very thing that led to the genocide, by prohibiting tribal identification as Hutu or Tutsi. Everyone is a Rwandan, and just that. If you are caught self-identifying with a tribe or identifying someone else as part of a certain tribe, you could be sent straight to jail. But apparently he has his opponents as well. He is accused of continued killing in Rwanda and Congo, jailing political dissidents, and limiting independent press. Funnily enough, while I was in Kigali over the weekend, President Kagame was in Chicago for Rwanda Day, a celebration of the country and its progress. He was greeted by a group of supporters on one side of the Hyatt Regency downtown, and a group of protestors on the other side.