Focus Student Scene Spotlight

Student Scene December 23/December 30, 2002 Photo by Jeff Cleary A Promise of Care Gears crunching, we round the bend and arrive at a crest above a valley that rolls into the distance with vine-laden acacia trees. Smoke rises from fires hidden beneath the foliage here, in this military zone. We have been warned not to travel in the dark of night or early dawn--foreigners have been attacked in these woods before. A green mist settles over the rust-colored brush, surrounded by cliffs as red as the Tutsi blood spilled here only weeks ago. Blackness peers between slim, pale trees ringed by sun-scorched ferns. Herons fly up in a panic. It is August 1994, only a few weeks after the massive genocide in Rwanda that left nearly a half million Rwandan Tutsis and Hutus dead. I have stumbled into a position as part of an early humanitarian mission charged with helping the fledgling government to restore order. My task seems straightforward enough--to help the Ministry of Health reintroduce a system of reporting morbidity and mortality. So my government counterpart and I begin traversing the countryside to disseminate our stack of forms and instructions about filling them out. We bring high-protein biscuits and milk powder as well, to make our visit a bit more welcome. The Devastation En route, I am struck by the emptiness of the countryside. We pass clusters of abandoned huts, town after town empty of all but a few cattle, perhaps a looted church, the remains of a burned state building surrounded by abandoned crops rotting in the sun. Overhead a tattered national flag twists in the wind. A war is won, but for whom? The people have scattered. Leaving their homes, they have hidden themselves in the refugee camps of Tanzania and Zaire or displacement shelters in the southwest of the country. Some brave few may still be living in the bush. I feel indescribably powerless and envy every worker who at least can offer some rehydration fluids or medicine to the sick and dying. --Alisa Land Many of those who have survived, as is often the case, are women and children who have lost their men to war. Dimly through clouds of red dust, I see a woman bending almost double and hacking at the clumps of dry soil beside the road, a tiny infant strapped to her back. Other women line the roads, upright and barefoot, balancing incredible loads of firewood, buckets of water, huge sacks of donated grain. Older girls carry the younger infants balanced on their tiny hips, already bearing the burdens of an adult. Leaving the safety of our vehicle, we wander among the makeshift villages in refugee camps. Twisting mud paths separate rows of huts made of twigs and covered with blue plastic sheeting while outside the curling smoke of cooking fires stings my eyes. We have all discussed, in some safe place, the psychological effects of war trauma, but now it becomes real to me. Reflected in so many hollow eyes, wide but unseeing, are countless unspeakable acts witnessed and suffered. I cannot get used to the flat and unemotional retelling of yet another tale of atrocity, horrors so endless and universal that the more startling story would be to meet someone without a story. The older children cluster and follow me like a modern pied piper, fascinated by my white skin and strange hair, while the babies see my freakish appearance and can only scream, clinging to their mothers' breasts. I huddle inside a few of these makeshift homes and hear their stories. I speak with a 12-year-old girl named Profia who told me how she lost both her parents in the war and is now raising her two younger siblings alone in the camp. I remember a woman who told me that she had fled with her 10 children in tow. She tore her dress into 10 fragments for each to hold onto as they ran from their attackers. Her eyes streamed with tears as she told me that when they finally reached the forest, only six of her children remained. She knew that she could not return for the others or they all would die. Finding Something to Give On the road, I speak with a man who walks on his hands now, having lost both his legs in a mine field. We visit Goma during a cholera epidemic and see row after row of bodies--some wrapped in leaves, others left nearly naked--waiting to be burned. The acrid smell of burning flesh and disease hangs heavily over the camp. I feel indescribably powerless and envy every worker who at least can offer some rehydration fluids or medicine to the sick and dying. Meanwhile, I carry only my forms to document so much pain, making careful notes about the many causes of illness and death--whether cholera, dysentery, or malaria--to be entered into a computer database back in Kigali. Finally, weary of the filthy roads, mud-encrusted bodies, and mingled scents of sweat, urine, and roasting goat, I climb back into our four-wheel drive followed by a wide-eyed man who stretches bleeding palms out to me through the open window. Driving away, I see the genitals of a small boy perhaps two years old who is dressed in a pink dress too short to cover him. I wonder what I can do with my forms and biscuits and milk powder to erase their pain? Woven into this tapestry is a promise I made to these people and to myself. I decided that I would not return to this place empty-handed. So I came to medical school in order to train myself to be able to serve and heal those in need in very concrete ways. Though I still do not know exactly what type of medicine I will practice or with whom, I trust that when the time comes, I will have the courage to keep my promise. --Alisa Land, a third-year medical student at HMS The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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