All That Is Bitter and Sweet_ A Memoir - Ashley Judd [182]
From the air, I could see why Rwanda is called the “Land of a Thousand Hills.” Its peaks and valleys undulated below me, green and terraced and graced with lakes. While I admired the landscape I began to register what I had heard, that every square inch of the land is tilled in the effort to feed all ten million people living here. They have already run out of space, and there are predictable environmental consequences: massive deforestation, erosion, loss of biodiversity. I was warned that I would never be alone (something I need at least a little of daily), as even in the most remote parts of the country, people would be … everywhere. And it’s true, they are. No matter how much I hunted for a discreet place to pee, I could never find one. Even unpaved rural roads are lined with folks walking somewhere, perhaps in a blue school uniform or with baskets of goods or a jerrican of water on their heads. There is no way Rwanda and other countries can overcome their problems unless the population growth is reduced.
We landed in a giant field in the Est Province, greeted by hundreds of onlookers who were curious about the helicopter. Cries of mzungu—“white person”—erupted as my colleagues and I climbed into our cars. We jolted across rough, red dirt roads to visit a community of health workers in action. Our guide, Pierre, was elected by his fellow villagers to become the village’s health worker. Once chosen, he received intensive health services training, which is ongoing. Pierre carries a bag with lifesaving pharmaceuticals, such as antibiotics, family-planning kits, malaria treatment, and first-aid materials. He is available in his home and goes to those who are too unwell to traverse the mountains. If the case is too difficult for him to handle, Pierre refers the patient to the local clinic. He also follows up and makes sure patients take their medications for AIDS and tuberculosis. It’s a wonderful program that allows primary care to reach the poorest and most remote areas.
In a small, bare home, we visited a broken woman holding a limp infant. Pierre had diagnosed malaria in the baby and was teaching the mother about her new insecticide-impregnated net and the proper use of Primo, the lifesaving treatment that PSI packages and markets especially for children. When I sat with the woman, she was not easy to engage, she herself was so ill and overwhelmed. I tried to squeeze in a few quiet moments with her, as I am not a breeze in, breeze out, kind of gal. My only real contact with her, however, was that she smelled so rotten I actually had a gag reflex, a first for me in eleven countries of slums, brothels, and hospices. Water is so scarce here, and it is such hard work to fetch it, that one drinks it mostly, then perhaps uses it for cooking. Washing oneself is a very low priority in this country. I felt very sad. I didn’t even learn her name.
In back of the minuscule house, another woman who rented the bedroom proudly showed us her treated net hanging over her bed. She was wearing a matched lavender outfit, and we sat under her net giggling, unable to understand each other with words but giddily connected somehow, excited just to see each other and hug.
The minister, Dr. Ntawukuliryayo, a long, lanky, hyperenergetic man, would not be lingering long at any of our stops. We continued on our tour of rural clinics in a convoy of government, USAID, UN, WHO, and PSI cars. Lurching and heaving over rutted roads, small black faces joyfully yelling, “Mzungu!” wherever we went, we arrived at an open-sided building where rows and rows of locals were sitting on wooden benches on a poured-concrete floor under a corrugated tin roof. They were waiting patiently for medical services, and by the look of it, they would need that patience—it was very crowded.
The wards were bare cement rooms with simple aluminum cots lining the walls. The beds were all filled, mostly with mothers nursing their newborns. The minister and I stopped at each bed to talk about how undeveloped children’s immune systems are and why sleeping with