Monday, June 16. Rwinkawavu, Rwanda.

 

We’re on a three-hour drive from Kigali, passing through a landscape as rich and green as the north coast of Kauai or the tea plantations of southern India. I’m going to observe a medical facility opened by Partners In Health, the amazing organization started by Dr. Paul Farmer, whose work in Haiti inspired the Tracy Kidder book, “Mountains Beyond Mountains.” Rwinkawavu is remote, and until PIH it had no medical services at all.

(For more on Paul Farmer and “Mountains Beyond Mountains,” go to www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/02/08/DDI9UOVJR.DTL.)

Henry Epino, Partners in Health’s Rwandan medical director

Henry Epino, PIH’s medical director in Rwanda, is my driver and guide. He’s from Danville, California (near Oakland), went to Stanford, quite brilliant. Annie Kalt, a young woman with a kind, vulnerable face who is here with PIH for one year, joins us. Henry is a dynamo, smart and talkative, with the hurried, unkempt look of someone so dedicated to his work that he forgets to shave in the morning. He’s been with PIH since working at one of Harvard’s two medical schools, at first in Boston (PIH headquarters) and later in Peru, Haiti and Russia where the organization curbed a tuberculosis epidemic in prisons. Before Rwanda, Henry worked two years with AIDS patients in Malawi on a Fulbright scholarship.

Roadside scene in Rwanda

Mild weather all day. Rwanda’s population density is such that, even as you drive through the countryside, there’s a constant hum of activity. People everywhere, walking or cycling on the shoulder of the road. Schoolgirls in electric-blue uniforms, schoolboys in buff uniforms.

I see a man portaging a huge, shaved tree branch twice his size – at least 12 feet long. Probably eucalyptus. He balances it atop a folded cloth on his head and keeps it balanced as he maintains a steady trot. Men walk their bicycles, which function as donkeys or wheeled dollies: huge loads hanging on each side like saddle bags, a larger burden on the bicycle seat. Children wave as we drive by and men stare into the van, sometimes studying my face as intently as I study theirs.

Rwandan children in school uniforms

Henry speaks Kinyarwanda, but not much French, and teaches me a new word: Muzunga, which is Kinyarwanda for foreigner. It’s used the same way that “gringo” is in Latin America, but probably with a friendlier attitude. Muzunga, c’est moi.

Entrance to Rwinkwaku clinic

The hospital and clinic at Rwinkawavu are very much the way their Haitian equivalents are described in “Mountains Beyond Mountains.” Simple yet comfortable buildings, well-equipped, with tile floors instead of concrete. There’s a humane approach central to the Partners in Health: patients are treated with respect and dignity. Correspondingly, the stone pathways connecting the various buildings are beautifully landscaped with hanging vines in full bloom and large, lush borders of bamboo and bougainvillea.

Gardens at Partners in Health clinic, Rwinkawavu

The complex is built on a hillside and includes 15 to 20 buildings. There are only four full-time American staff, lots of PIH volunteers and 300 Rwandan staff. The model is centered on passing the expertise onto Africans so they can operate and eventually oversee the operation. “I’m trying to work my way out of a job,” Henry explains.

Henry Epino with a patient

Henry shows us the pharmacy, lab, maternity and pediatric wards. I love the fact that when you walk through the pediatrics ward, most beds are occupied by a child with the child’s mother at his or her side. The mother will stay here until the child’s treatment is complete.

Young girl at Rwinkawavu clinic

One little girl has a steady, pained cough and enlarged cheeks – renal failure. I snap her picture three or four times and then approach her and her mother to show them the digital result. As we leave, Henry thanks me and says it’s important for patients to be acknowledged that way.

Pharmacy

Henry Epino, Annie Kalt (center) and colleagues at Partners in Health’s Kirehe clinic.

The tour at Rwinkawavu is followed by a quicker tour of PIH’s second medical complex in Kirehe – an hour away. Henry and Annie both have pieds-a-terre in Kirehe and it’s late in the afternoon, so I’m driven back to Kigali alone. The first part of the drive is gorgeous in the amber “golden hour,” but the second part is in the dark, on an unlit road. I’m amazed more people aren’t killed on the roads, given how casual Rwandans are about strolling or biking on the roadside. They seem to have blind faith that drivers will see them.

Road police in reflective yellow vests are everywhere, and traffic frequently has to slow down for speed bumps. Seat-belt laws are enforced and everyone on a motorbike is required to wear helmets. In the brief time since these laws were established, road fatalities have dropped dramatically.

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