Sunday, July 29, 2012

Mushanana Madness!

Excuse me?  A what?

That was my response to being told by my Rwandan big sister that I was going to attend the wedding of her cousin, and that I was invited to take part in the entire celebration, which meant I had to wear a mushanana for the Introduction Ceremony (see photo to the left). A mushanana is the traditional wedding attire for women, both in attendance and in the bridal party, but only for the Introduction Ceremony. It is generally made of a silky and flowing fabric, which looks beautiful in the breeze. At the time, I had no idea truly what I was in for, or what the day would entail. 13 1/2 hours after I stepped foot in the saloon (what is known as a salon in America), I would be told that there were still 2 more ceremonies to attend! That's one heck of a wedding day!
Coming into this experience, I really wanted to immerse myself in the culture of Rwanda, and to embrace every opportunity I had to get a view of life in my new country.  I had heard stories of Rwandan weddings, and each time I am in Kigali, I see many processionals of cars either heading to or from weddings, so when I was asked to attend a wedding, there was no decision to be made - I was in!  
The Introduction was the first event, not counting the hair and nails getting done by those in the wedding party at the aforementioned saloon.  Some Rwandan weddings have the Introduction Ceremony several weeks, and even months before the actual wedding, but on this day, everything was wrapped into one long day.  It was held at the home of a relative of the bride, and the setting was quite idyllic (see photo to the right).  The bride's family and guests sat on one side of the yard under a tent, and the groom's family and guests sat across the way.  There was a third tent in the middle, intended for the bride and groom and the wedding party.  The Introduction consisted of many long speeches from both sides, essentially extolling the virtues of both the bride-to-be and groom-to-be.  After the speeches, the discussion about the dowry began and essentially the groom's family and cow caretaker conveyed the "value" of the bride and listed what would be given to the bride's family in exchange for her.  That's a crude way of explaining a dowry, but essentially when it comes down to it, that's what a dowry is.  The cow caretaker's speech was my favorite, as he explained how many cows the bride's family would get, the health of the cows, the amount of milk the cows produce, etc. and after each sentence, a mooing soundbite was played by the DJ.  It was entertaining if nothing else!  After the dowry discussion, giant bottles of Coca-Cola and Fanta were exchanged by the fathers of the bride and groom, toasts were made, hugs were given, and the bride was officially presented to the groom and each met each other's families (I am still not certain if this was their first meeting or not).  The whole ceremony took a little over 2 hours, and I was not even half-way through the day. 
Next stop - the church!
I changed out of my mushanana and into a dress (which was chosen because it covers my knees), and headed across town to a church.  It was an exceptionally hot day in Kigali, and the heat only intensified as I entered the non-air conditioned church which didn't have any windows that opened.  Throughout the hour and a half ceremony, I think I faded in and out of either sleep or consciousness on several occassions...I'm still not certain.  Imagine sitting in a sauna while a wedding ceremony took place in a different language, and you can begin to understand how I felt.  The most amusing part was that on top of the natural heat, the photographer was running around with a mega-watt spotlight, taking pictures of anything and everything, which always seemed to circle back to me because I was one of two token Mzungas at the wedding.  The ceremony eventually ended and everyone raced to the doors to get a breath of fresh air.  Next stop - the reception!
The reception surprised me, to say the least.  It surprised me on several fronts, the first being that it was set up very much like a Western-world wedding reception with tables and chairs and decorations and a dance floor.  It was also huge!  (see photo to the right)  Based on the limited number of people at the Introduction Ceremony, and even fewer people at the Church, I assumed the reception would be a small affair.  Shortly after arriving and mingling with guests, I soon learned that most Rwandans know better than to go to EVERY event on a wedding day, but choose wisely and only attend the reception.  Like I said, it's not so different from the Western world :) 
Instead of a bar, there were bottled drinks on each table (Fanta, Coca-Cola, local beer, water), and everyone sat wherever they desired.  My friend and I sat at an empty table that quickly filled up with Ugandan men.  My friend and I soon became aware of the difference between men who were born and raised in Rwanda, the Congo, Burundi, and Uganda.  The men at our table spoke at us in a rather assertive way, and what began as an enjoyable event quickly made my friend and me want to run for the hills and put our pjs on and call it a night.  But, being a feisty girl who grew up with 3 older brothers who taught me how to stand up for myself and speak my mind, I began to battle back during the discussions, and began asserting my opinion and asking questions.  My friend joined in and what started as a one-sided, male-dominated conversation quickly transformed into a discussion about cultures, beliefs, morals, and worldly events.  In other words, it became interesting.  I don't think the Ugandan men knew what they were in for when they rushed over to sit at my table :) 
Several hours passed, and several things became crystal clear:  1) The only dancing that would happen would be performed by traditional dancers, 2) Each person who brought a wedding gift would go up and present their gift to the bride and groom one-by-one (yes, it took FOREVER), and 3) Worst of all, the 15 wedding cakes on display (complete with mosquito netting to keep the flies and moths away) were not for us to enjoy, but rather were gifts for key people in attendance who had played a role in the wedding preparation.  Being somewhat of a cake fanatic, and not having access to any cake in Rwanda, I was beyond disappointed at that revelation! 
At just before 10pm, the buffet line opened and dinner was served, and just when I thought that I was handling things well and going with the flow, the flash bulbs began going off and I quickly realized that my friend and I were the subjects in all the photos.  Being the only white people at a Rwandan wedding was somewhat of a "special" thing, and the guests acted like paparazzi, taking photos of us whenever they had the opportunity.  Literally mid-bite, I would see a flash go off - I can only imagine what that photo looks like on someone's Facebook page! 
After the reception, there were two additional phases of the wedding - 1) going to the bride's home (women generally live with their parents until they marry), collecting her belongings, and assisting with the "move" to the groom's house, which the bride and groom will now share.  Traditionally the bride also chooses a close friend or relative to live with her and the groom for the first few weeks of marriage to cook, clean, and tend to the house while the bride settles into her new routine as wife.  2) a celebration at a local nightclub or hotel, where dancing commences until the wee hours. 

13 1/2 hours after I began my day at the saloon, I walked out of the reception feeling drained, dehydrated, and somewhat verbally attacked, so I called it a night, skipped out on the last two phases of the wedding day, went home and celebrated in my own right by putting on my pjs and crawling into bed.  It was a long and interesting day, and honestly I am honored to have been a part of it.  Having said that, I think I have had my fill of Rwandan weddings. 

Tuesday, July 17, 2012

Mountains Beyond Mountains

I just finished reading the book, Mountains Beyond Mountains by Tracy Kidder.  Although the title makes it sound like a story about Rwanda and it's Land of A Thousand Hills, as it is widely known to have, it is mostly about Haiti.  The story is an inspiring account, following Dr. Paul Farmer as he tackles some of the world’s most pressing medical issues by bringing modern medicine to those who need it most in developing countries.  It documents the trials and tribulations of his quest and illustrates that one person truly can make a difference in the world.  I am not a non-fiction buff, but this book was passed along to me because I was invited to visit one of Dr. Farmer’s projects in Rwanda – Partners In Health (PIH) Rwinkwavu (Southern Kayonza District), or Inshuti Mu Buzima as it is called in Kinyarwanda.  One PIH motto is “providing a preferential option for the poor in health care,” and that is precisely what I saw in action when I spent a day in the rural area that surrounds PIH Rwinkwavu. 

In partnership with the Rwandan Government and the Clinton Health Access Initiative, PIH is working to build upon and enhance the public health system in three rural districts in Rwanda.  The project was designed as a comprehensive primary health care model within the public sector.   There is a 150-bed state-of-the-art hospital and cancer center (opened in January 2011) along with 15 health centers in Butaro, a 120-bed hospital and 14 health centers in Kirehe, and a 110-bed hospital and 8 health centers in Rwinkwavu.   The entire Rwandan project serves a catchment area of 800,000 people through three district hospitals and 37 health centers.

The tiny nation of Rwanda is the most densely populated country in Africa, with a population of more than 10 million in an area smaller than the state of Maryland. Rwanda is one of the poorest countries in the world, ranking 166 out of 187 countries listed in the U.N. Development Program's Human Development Index.  As if it didn’t have enough challenges to overcome, the 1994 Genocide Against the Tutsis resulted in a massive loss of health professionals and the collapse of health infrastructure. The prevalence of AIDS in Rwanda today is in part, a consequence of the genocide. Estimates vary, but it is believed that between 8 and 13 percent of the population is infected with HIV.

Rwanda faces an acute shortage of medical personnel, with only one doctor for every 18,000 people. In the rural districts where PIH is based, the shortage is even greater.  When PIH began work in 2005 in two districts in southeastern Rwanda, there were an estimated 500,000 residents living there, without a single doctor.  PIH’s first order of business when they began working in Rwanda, at the request of the Rwandan Ministry of Health, was to introduce quality AIDS prevention and care to these rural districts, while at the same time addressing other medical and social issues, such as the following:

·         Malaria is a major cause of death among children and adults in the area
·         Maternal mortality rates are high. One out of every 25 women die during childbirth, because family planning and obstetric care are unavailable in rural regions
·         Common illnesses that can be prevented with vaccines, treated with antibiotics and survived by those who are well-nourished continue to kill thousands of Rwandan children
·         Tuberculosis is currently the leading cause of death among Rwandans with AIDS and kills many others who are not infected with HIV
·         Hunger and malnutrition are major contributors to many deaths and are the principal cause of death for many Rwandan toddlers

Rwanda's Inshuti Mu Buzima (IMB) Project Timeline (taken from
2004 – The Rwandan government invites PIH to reinforce the national HIV prevention and treatment program in rural areas

          The Rwinkwavu hospital is reconstructed and reequipped (see photos below), and training begins for clinical staff and community health workers. 
          HIV testing is offered, and by the end of the year, 17,000+ people have been tested and nearly 700 started antiretroviral therapy (ART). 
          1,000+ patients visit the clinics each month and nearly 5,000 women receive prenatal counseling, 700 food packets per month are being distributed per month to HIV and TB patients and their families.  

          A 30-bed pediatric center is built at Rwinkwavu Hospital (see photos above), fully renovated operating rooms open, and workers begin working in four health centers in Kirehe district, where there are an additional 350,000 people. 
           1,500+ food packages are distributed each month, and the World Food Program distributes an additional 1,000 per month.
           IMB builds more than 35 houses to support social and economic rights, pays secondary school fees for nearly 400 students, and creates skill-building workshops which provide jobs. 
           At the end of 2006, 2,000 patients are enrolled in ART, 800+ community health workers are visiting patients daily to distribute and monitor medications, and a total of 91,325 patients visit IMB.

          IMB, along with the Ministry of Health launch a rural health initiative to bring quality health care to every rural district in Rwanda.
          Burera hospital is renovated, and plans for a new hospital are made.  Burera is home to 400,000 people, who had previously been served by 1 doctor and no functioning hospital.
          1,200 community health workers begin staffing the community-based model of care.
          IMB expands to a seventh site in southeastern Rwanda, and establishes chronic care clinics at all of its sites.

           A new district hospital in Kirehe is completed
           An agricultural training center at Rwinkwavu Hospital begins producing food for hospital patients and provides free agricultural education for parents of malnourished children and HIV/AIDS patients (see garden and sapling photos below)

    IMB provides training and salary support for community health nurses, supervisors and workers to care for Burera’s 400,000 people and 13 health centers  

2012 – 

Although my visit to the PIH/IMB Rwinkwavu Hospital and training facility moved and inspired me, the part of the day that left an indelible impression on me was when I went along with PIH workers on a site visit to one of their patients, who they have been working with for over 5 years.  It was there when I met the little boy (pictured above, to the left), who was featured in one of my previous blogs.  This little boy’s mother faced unfathomable challenges when she returned from exile in Tanzania after the Genocide.            
PIH built her a house (pictured below), provided her with antiretroviral treatment, provided clothing for her family, along with prenatal care (she was 6 months pregnant with the little guy pictured below), and professional development skills which ultimately led to her successful agricultural business.  She is now a model citizen in her rural village, welcoming less fortunate neighbors who have fewer resources into her home. I spent time in her aluminum-roofed house where she, her elderly mother and four children share three rooms, sleep on mattresses on the concrete floor (under mosquito nets), and run a small business.  PIH saved this woman’s life, gave her children a mother, her mother a daughter, and rescued her from a calamitous situation.  Her son ran into my arms during my visit to the home, and stood, mesmerized, staring into my eyes for most of my stay.  I saw the value of PIH’s work in his eyes.  Where many would have seen dirt and poverty and sadness, I saw hope and love, and a future – not just for this family, but for Rwanda as a whole.

In addition to Rwanda, Partners In Health works in some of the most dire parts of the world – Haiti, Lesotho, Malawi, Mexico, Peru, Russia, Kazakhstan, with additional partner projects (projects that are working to implement the PIH model across the globe) in Burundi, Guatemala, Liberia, Mali, Mexico, and Nepal.  

For more information on Partners In Health and their projects all over the world, visit

Friday, July 6, 2012

holes in my flip book

“Sometimes, when one person is missing, the whole world seems depopulated”

-Alphonse de Lamartine

One year.

One year of sadness.

One year of tears.

One year of unbelievable pain, in the core of my soul.

One year of not understanding and having unanswered questions.

One year of not being able to grasp reality.

One year of shock.

One year of firsts without him.

To be honest, I don’t remember a large portion of the past year. The thoughts that do come flooding through my brain revolve around that fateful day on July 2nd, 2011, and bits and pieces scattered throughout the 12 months that followed – the memorial service, planting a tree in Kurt's name at Georgia Tech, my last day at my job, moving my life into a storage unit, my dearest friend Michelle’s wedding, saying goodbye to my parents as I left for Rwanda, meeting my Rwandan “family” for the first time ... it’s like a flip book, without a complete storyline. The grief books say that when you go through a traumatic loss, your mind shuts down and only allows you to remember snippets of life throughout the grieving process, so as to protect you from being overwhelmed all at once. Maybe someday my flip book will be complete, maybe not. Maybe my flip book of life is meant to have a few pages missing. Maybe some memories are best left forgotten.

I imagined that after one year of firsts, the pain would lessen, the days would be filled with more joy, and the heaviness would ease. I discovered this week that on day 357, 358, 359, and today on day 360 that the pain is still gut-wrenching, the weight of it all is oppressive, the emptiness in my heart still feels like a gaping hole, and that the days go on and continue to add up as days without my brother in this world. Yes, the tears that are shed are fewer and far between, but they still drip down my cheeks nearly every day. I don’t know exactly what I expected it to feel like after year one, but it still feels awful and raw.

I feel so far away at times from where my brother is - worlds apart. At night, I look at the stars above, and only hope that he is close to me - closer than I can tell, and closer than I can feel. I miss the years that were taken from us, from him, from this world in which he lived. I already miss the moments that have yet to unfold, knowing that he won’t be present – physically at my side. I miss the things that never dawned on me as mattering. I hear his voice and see him in my dreams. I imagine turning around and seeing him in life. I wish he were here. Wherever he is, I hope he knows how much he is missed.

If you think it can’t happen to you, it can. We are all just one phone call away from our knees and from realizing that a new normal has begun.

One year ago my brother was killed. One year ago my new normal began. One year ago an article was published that shed light on the dangers of distracted driving, and on the importance of paying attention both as a driver and as a rider. As my dad told me when I got my driving permit, "You have to be a defensive driver because although you know what you're doing behind the wheel, there are plenty of morons out there who don't." I still read the article every few weeks, and would like to share it with you in case you need a reminder of why you should respect the rules of the road.

LESSONS FROM THE WRECKAGE: Tragic death a potent reminder about simple rules of the road for bikers and motorists – by John Cork