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There was tough work to be done on this trip. Rwanda is the most densely populated African country, with more than ten million people squeezed into an area the size of Maryland. It is also one of the poorest and most traumatized places on earth in the aftermath of a long series of genocides, culminating in the unspeakable genocide in 1994, in which eight hundred thousand people were murdered in the space of one hundred days and millions were driven from their homes. PSI is one of the NGOs that the Rwandan government has invited to help it build a community-based health care system as a foundation to lift its people out of abject poverty. As always, I was here to see our grassroots programs and others’ in action—particularly our child survival initiative called Five & Alive—to celebrate what works and the workers who do it, and to help carry the good news back to donors and policy makers that this remarkable country is lifting itself out of the ashes. For example, Rwanda has been outperforming most African countries in meeting its United Nations Millennium Development Goals, which provide a framework and set targets for poverty alleviation, education, child and maternal health, HIV and other disease eradication, and gender equity.

But there is no way to begin to understand the depths of Rwanda’s agony, or its soaring promise, without first plunging into the original heart of darkness. The genocide inescapably informs everything in this country and most certainly the public health mission here. It is the background, acknowledged if unspoken; it has set Rwanda’s stage.

So once again, as I did in Cambodia, I began this journey with a visit to a genocide memorial.

In an angular, sand-colored building surrounded by gardens and graves, the exhibits are divided into three parts: the roots of the genocide, the events of 1994, and the aftermath. The narrative format is so familiar to me: This is what I was. This is what happened. This is what I am now.

The first of three chambers was lined with black-and-white photos from Rwanda’s colonial past. First the Germans and then the Belgians claimed authority over this volcanic plateau southwest of Lake Victoria. According to the accompanying text, Rwandans identified themselves among eighteen clans, of which distinctions like Hutu and Tutsi were occupational and not tribal/ethnic at all. The colonists made up that all Tutsis were Nilotic pastoralists and Hutus were Bantu peasant farmers. One of the most enraging images was a 1932 photo of a Belgian priest, for God’s sake, a priest, measuring Rwandans’ heads and categorizing them ethnically for registration cards. Once the massacres began in 1994, these registration cards established the delivery system of death for nearly a million people.

Set up by the Belgians and the Catholic Church, the Hutu majority took over Rwanda at independence, and some seven hundred thousand Tutsis fled to other countries to escape an eruption of ethnic cleansing that began in 1959. Still, more than a million Tutsi remained in Rwanda, some intermarried, and most lived in peace with their Hutu neighbors. In 1990, a Tutsi rebel army known as the Rwanda Patriotic Front invaded Rwanda from neighboring Uganda in order to force power sharing with the Hutu government. After years of fighting, the United Nations brokered a peace accord that would allow the Tutsi diaspora to return and establish a multi-party government. This enraged Hutu nationalists, who viewed the Tutsi as “cockroaches.” A fanatic Hutu propaganda machine had been whipping up paranoia and hatred of the Tutsi and their sympathizers. On April 6, 1994, a plane carrying Rwanda’s president was shot down as it was landing in Kigali. Within an hour of the president’s assassination, the army and Interahamwe had set up roadblocks in Kigali, and an orgy of orchestrated mass murder began.

There is no part of Rwanda that was spared the rampage of génocidaires. Local militias had lists of the names and addresses of Tutsis and moderate Hutus, and they hunted them