ARC In The News

After genocide, a ray of hope
Ann Y. Kao, The Boston Globe, February 20, 2006

Dr. Ann Kao worked with the American Refugee Committee in Rwanda as a Durant Fellow, providing health care to Congolese and Burundian refugees.

THE LIGHTS from the vehicle pulling into our yard shine in through my thin curtains, throwing shadows against the ceiling. I check the clock, it's 4:17 a.m. I get dressed in the dark. I meet Seraphim, our driver, on the starlit porch. We climb into our jeep wordlessly and drive down a rough dirt road and up a hill dotted with the green and white tents the United Nations has provided as shelter in this remote refugee camp. One houses my health center and hospital.

''C'est un enfant," Seraphim says. In the hospital tent, two nurses, Louise, a Rwandese Hutu, although nobody overtly mentions ethnicity here, and Betty, a Congolese Tutsi, are crouched over a 2-year-old's unresponsive body.

His name is Micyo. There is a slight twitching of his arms, and his eyes are open staring to his right. His breathing is shallow, and his mother watches in silence. His mother and the nurses had been trying to place an IV for two hours before deciding to send Seraphim for me.

I'm the only physician serving 5,000 Congolese Tutsi refugees in the hills of northeast Rwanda. My work has left me both angry and inspired, exhausted and exhilarated, and desperate and feeling complete peace -- often all at the same time.

I chose Rwanda because I wanted to see for myself this place where the most brutal and unspeakable of horrors were committed a decade ago. I wanted to understand, to see the survivors, and to feel the ghosts of those slain. I wanted to find some reassurance, some justification, some explanation that it would convince me that genocide -- the slaughter of an entire group -- carried out by close neighbors and relatives is an anomaly.

There are 19.2 million refugees at last count; more than 4 million live in Sub-Saharan Africa. Such natural disasters as tsunamis, earthquakes, and floods take their toll, but man-made disasters lead the list in Africa, and the conflicts in the Congo and Sudan are two prime examples.

The Congolese Tutsi refugees here now in Rwanda are living reminders of the 1994 genocide that claimed nearly 1 million lives. Their ethnic enemies, the Interhamwe, still roam Southern Congo. After 10 years they continue their campaign to rid the world of Tutsis. These refugees have fled here to survive.

For these refugees, hidden horror stories float like algae just millimeters below the calm surface. Their stories are told slowly, softly, sorrowfully. In a rare moment of calm between malaria patients, Nicole, my head nurse, a Hutu, tells me her father was killed eight years ago by the Interhamwe. They surrounded a bus he was on, doused it with gasoline, and set it aflame. It didn't matter that he was a Hutu; he was on the wrong bus.

Seraphim, the driver, tells me late one night how his wife and three children were killed in '94.

Richard, another nurse, tells how his mother, father, and seven brothers were slaughtered in front of him by his neighbors -- adults who had cared for him, men he knew as children, former playmates.

I find it hard to look into people's eyes. Rwandans avoid eye contact, and I am beginning to understand why.

Because Rwanda's courtrooms, lawyers, and judges are woefully inadequate to handle the crushing caseloads stemming from the genocide, ''gacaca," a conflict resolution process based on ancient customs, has been reinstated. Publicly, gacaca is touted as a way of finally putting demons to rest, but privately nearly every Rwandan I have spoken to says it's not true justice, but there is no other choice.

My camp is new; it was just three months old when I arrived in July. Five thousand refugees, most younger than 18 and more than 1,000 younger than 5, live in the camp.

It is a camp full of children, and children taking care of children. Often it feels like ''Lord of the Flies" meets ''Survivor."

Malaria is rampant; a third of the population display symptoms at any one time. The monthly World Food Program rations of dried corn and beans always seem to run out before the next month arrives. Adults and children have chronic infestations of scabies, ticks, and worms. The rocky soil makes any kind of farming nearly impossible, even if there was the space.

The children all have their own stories; they are preternaturally wise, at least the girls are. They shoulder much of the burden of caring for the younger children. It is common for a 7-year-old holding a baby to bring a 2-year-old in for treatment.

The resiliency of these people humbles me every day, especially when I am tired of the ovenlike heat or the drenching downpours. Whenever I visit the camp, I am mobbed by smiling refugees. They reach out with dirty, yet eager and friendly hands.

It's not all fairy dust and Tinkerbells, though. There's corruption, violence, greed, and all of the ugliness of humanity. Last week, a 7-year-old was playing with a grenade that her father had brought into their tent. It exploded, killing her instantly, wounding several others. It makes me angry and sad, but at least here I feel like I am doing something to change it all.

This camp is as far removed from the Massachusetts General Hospital as one can imagine. I have no medical safety net here, there's no directory of specialists to dial up, although e-mail has been a powerful tool, when it is working. There is no oxygen, no ventilator, and, until recently, not even a basic laboratory. It is medicine as artistry more than as science.

I've learned what multitasking really means. I am the camp physician, and that makes me an administrator, an epidemiologist, a nurse, a janitor, a pharmacist, a judge, a mediator, an advocate, an educator, an engineer, a politician.

In the medical tent, Louise, the Hutu nurse, holds the hand of Micyo's mother, a Tutsi, if anyone is still counting, as Betty, the Congolese Tutsi nurse, prepares medicine for the boy. Betty places drops of sugar solution slowly under Micyo's tongue while I search for an IV. Soon his seizures stop and he sits up and calls to his mother. Louise is still holding the mother's hand as she says something to me in dialect. Betty translates, ''If we were in the Congo, my child would not be alive now."

I look around the tent and see the soft glow of the rising sun on their faces and in this light they are all a blur, or maybe it's the tears in my eyes. I feel at this moment that this country -- these people -- can move on. For them, it will be slow and painful and the path is as rocky as the climb to my medical tent each day. But I know in this one moment that not all was lost in 1994, and not all is hopeless here now in 2006.

Dr. Ann Y. Kao, a physician with Massachusetts General Hospital, is a Thomas S. Durant Fellow in refugee medicine.

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