Before they returned to their normal lives in the U.S., both Leana and Will looked back at their trip in video form. Will has also selected a handful of his favorite photos for this slide show.
One of the most common comments we get goes: “What can I do to help? You guys talk so much about the problems, and now I want to do something.” I don’t like to bring up problems without proposing solutions. In this second-to-last entry, I propose concrete action steps to channel passion and idealism into activism and action.
Be forewarned that I don’t think that giving money is usually the best way to help. I believe that education, awareness and tangible actions multiple many times over. They are actions that, during your lifetime, will far outweigh infrequent monetary contributions. An aid worker at HEAL Africa summarized my thoughts when she said, “It’s too easy to give money and feel like you’ve helped. Doing something shouldn’t be about relieving your guilty conscience.” That said, there are many humanitarian organizations doing great things that rely on donor funds, and I do hope that you consider supporting them. I am just proposing other ways to help beyond monetary contributions.
Exposure to and understanding of issues is the most important, and most fundamental step, of “doing something” to help. Broaden your understanding through reading and traveling. Your voice as an activist will be much stronger if assertions are backed by evidence, and if your passion and conviction is grounded in reality.
Keep the big picture in mind. I agree with Dr. Paul Farmer that too many HIV/AIDS activists ask only for more money for HIV/AIDS while neglecting related issues like malaria, malnutrition, and primary healthcare. HIV funding should not be decreased, but rather, funding should take into account the big picture to develop a “horizontal” approach to improving overall healthcare.
Spend time abroad if you can. Nick often says that a college education is not complete without spending some time in a developing country: “How can you consider yourself educated if you do not know how 1/3 of humanity lives?” For young people, there are many opportunities to volunteer or work abroad. Consider programs like the Peace Corps and National Security Education Program. Seek out internship opportunities at an U.N. agency, NGO, or religious charity organization. Study abroad. Teach English. For those past college-age, there are similar types of opportunities available with NGOs.
My lasting image of Rwanda, the Democratic Republic of Congo and Burundi will be the children and the jarring contrast between their poverty and their beauty.
No words or images can prepare you for the poverty of the regions we visited with Nick Kristof. It is all-encompassing and numbing, the framework against which everything else happens.
The children’s clothes are holed and tattered, America’s washrags. If there are shoes, they do not fit.
Some children are mired in filth, dirt permanently clinging to their skin. More agonizing still are the children who emit a tangible aura of undiagnosed disease. You can look into their eyes and tell that they are not well.
And their desperate hunger is incomprehensible. I do not understand why their bellies protrude so fully when they are so abjectly malnourished. And yet I continue to shoo them away, trying not to think about what my eyes are seeing.
But cutting through the darkness of this poverty are the brilliant flashes of the children’s smiles.
I know a smile is only a smile. But for me, their smiles are symbols of hope and also reminders of their humanity.
I do not want to admit that sometimes I forgot that these children, struggling to strive in such bleak poverty, are still people, little different than you or me. They play games, they sing songs, they love their parents, they desire security, they seek an education, and, most importantly, they have hopes and dreams.
Obviously these children need and deserve serious international attention and assistance so they can obtain the basic rights that should be available to all humans, regardless of where they are born.
And this is why I so respect Nick Kristof and Leana Wen. It is a given that Nick is incredibly intelligent, a gifted writer and an indefatigable reporter. But he is also an activist for global change and equality. He genuinely cares about the people he covers and he wants you to care, too.
Leana matched Nick stride for stride on this reporting trip, from her in-depth questions to her intellectual curiosity to her desire to enact change to her fluency in French to her moves on the dance floor to her tenacious work ethic. These two, seeking to give a voice to the voiceless, physically wore me out the first hour of the first day.
Finally I am grateful to everyone, including my mom, who offered feedback about my photographs on this blog. I hope these photos offer a different perspective of the people who live in the poorest regions of Africa. Beauty exists everywhere.
Next week, I will be posting the best photos from our trip on my www.wjzo.com photography website in hopes that the young people of Chicago will see the similarities between themselves and the young people of Rwanda, D.R.C. and Burundi. We are all fellow people.
My friend Dr. Dan Rudasingwa is a general practitioner (GP) at King Faisal Hospital in Kigali, Rwanda. His family returned to Rwanda after 30 years of exile in Uganda to help rebuild the country. Now he wants to leave Rwanda.
Dr. Rudasingwa loves his country. He also cares about his own future. He wants to pursue specialty training in neurosurgery, which is not available in Rwanda. Everyday, he sees patients who need brain surgery, heart surgery, chemotherapy, or other specialized treatments to survive. There is no doctor who can provide these treatments. The best he can do is to watch the patients die. The only person he was able to “save” recently was a high-level official who was airlifted to South Africa after a head injury.
The problems with health care access in Africa are often attributed to lack of resources, but a more insidious and perhaps more difficult problem is the dearth of doctors.
Africa is facing a severe crisis of doctor shortage, on a scale almost unimaginable in the U.S. and Western Europe. Rwanda, a country with 10 million people, has about 500 doctors — a ratio of one doctor per 20,000 people. This is less than 10 percent of the World Health Organization recommendation. The vast majority of the country will not see a physician in their lifetimes. The Congo and Burundi have similarly poor ratios. Suburban U.S. hospitals could have more than 200 doctors on staff, while in Burundi, 165 doctors serve 8 million people.
The shortage of specialists is particularly acute. The only cardiologist in Rwanda is a Kenyan with a two-year contract in Rwanda. There are just 10 specialists for the 5 million people in the North Kivu province of the Congo. Even at the HEAL Africa hospital in Goma, which always has at least five visiting specialists, waits for gynecological and orthopedic surgeries be 60 days.
Where are the doctors? Blame is often — and rightly — attributed to the global brain drain. One-third of practicing doctors in the US trained in non-U.S. medical schools. Lower-income countries supply between 40 to 75 percent of these foreign-trained doctors. While one can hardly fault an individual like Dr. Rudasingwa for wanting to seek new opportunities, the developed world has an obligation to ensure that we are not poaching doctors from areas where they are most desperately needed. To meet American workforce needs, we should be opening more medical schools instead of taking individuals that other governments trained and need.
Many of you haved asked what you can do to help. I am working on a series of posts about the different ways you can make a difference. Stay tuned.
Given the proper equipment and training facilities, Africans should be able to dominate the sport of bicycle racing as they already do marathon running.
Young men use their bicycles as both a source of transportation and income. They travel vast distances between villages, up and down hills, carrying heavy amounts of produce or other goods over their back tires.
Bicycles also double as taxis. It is not uncommon to see a young man laboring uphill with two passengers seated on a makeshift cushion attached to the back wheel.
I love to ride my bike but there is no way I could manage these hills, especially not carrying 150 extra pounds of passenger. Their stamina and strength are astonishing.
And they are not riding the fancy 20-speed Schwinn zipping around flat-as-a-pancake Chicago. The bikes are old and ragged, but rugged. And treasured. The young men take great care of their bikes, washing them in the lakes every morning.
This is why programs like the Working Bikes Cooperative in Chicago deserve support. Working Bikes (www.workingbikes.org) salvages trashed bikes in Chicago, repairs them, and redistributes the bikes both locally and internationally. As their website points-out, (due to wage differences) “a bicycle worth $20 in Chicago can be worth the equivalent of $1,000 in Africa.
Those that cannot afford bicycles build these homemade wooden scooters, which looks like something off of the “Mad Max” movie set.
A little while ago, Nick’s blog included a comment by a student, Loren, who explained eloquently why she did not apply for the “win-a-trip” contest. She did not want to participate because she believed that too much of the coverage on Africa was negative, and thought that more of the coverage could be positive to highlight successes.
I disagree with Loren. Though it is important to celebrate successes, I do not believe in sugarcoating the truth. I believe in telling it as it is. Frankly, Africa as a whole is not doing well. By many accounts, it is caught in a poverty trap, and is the only region that had negative per-capita income growth from 1980 to 2000.
Let’s talk about the three countries visited on win-a-trip. We just left the Congo, embroiled in a brutal civil war that has claimed at least 4 million lives. Conflict and insecurity reign. Due to warring rebel factions, much of Eastern Congo in particular is on a downward trajectory. Soldiers attack each other and the population. Even government soldiers and the police loot, rape, and kill.
There is Burundi, the country we are in, ranking at the bottom of international poverty lists. Even Rwanda, our example of stable governance, is ranked 158 out of 177 countries on the 2006 U.N. Development Program’s Human Development Index. More then 83% of people live there on less than $2 per day. Its social indicators reflect the widespread poverty, for example, with one of every six children dying before the fifth birthday.
In all of the countries we visited, we heard stories of suffering and death, of lifetimes lost to disease, family, poverty, and violence, of bad politics and atrocious governing. These are real stories, and real issues that our readers need to know.
Are these stories unpleasant and difficult to read? Absolutely. Stories about successes, however small, are easier to digest than stories about failures. Who wants to hear about how an HIV program is failing to decrease mortality when they can hear about how many more people are on ARVs? Isn’t it easier to applaud the success of 2,000 bed nets being distributed than to ask why the mortality from malaria is still not decreasing?
Alice Walker observed, “Black women are the mules of the world.” Traveling across the poor African country of Burundi, we see women doing the majority of the hard fieldwork and, of course, all of the labor in the home.
We also drive by women of all ages transporting insane loads of goods and foods on their backs from village to village or to the market. These women are struggling up endless hills, stooped almost parallel to the ground, traveling miles upon miles. (Nick Kristof attempted to carry a 50-year-old woman’s bag and nearly toppled under the weight.)
Here in Burundi, the muling process begins early as few girls complete more than a few years of formal education. Why should a family continue to pay school bills (uniforms, supplies, etc.) for a girl when that child could be helping her mother work in the house? The girl’s future is already predetermined: marriage and servitude.
Today we visited a primary school in the province of Kirundo, where the World Food Program has implemented a new initiative that seeks to address the existing gender disparity in Burundi schools. All female students between the grades of four and six receive a take-home ration of food.
It is now more lucrative for a Burundi family to send their child to school than to keep her at home. The incentive program at this primary school has quickly proved a success as total enrollment has grown sharply.
Perhaps Chicago Public Schools should consider a similar program to address the alarming drop-out rate of black male students (predominately low-income.) Currently we expect these students to finish school because it is in their future best interests, and yet less than 50 percent (numbers vary according to source) graduate citywide, including where I teach at Westside Alternative High School.
Male students drop-out for myriad of reasons, however I believe most leave school because they do not or can not see how their high school classes or the resulting diploma is relevant to their future success. There are few older male role models in these low-income neighborhoods who can demonstrate that an education is essential to personal, career, and financial success.
Plus, school is boring as hell, no one seems to care, there is constant hostility and fights, and there is money to be made now, legally and illegally. So why should they stay in school?
A financial incentive for attendance, grades and behavior would address their current economic situations while providing them with a diploma and the framework to enter the workforce or college. More importantly, education will enable young, low-income urban black males, like the girls in Kirundo, to climb off society’s bottom rung in the climb to equality and respect.
I know, I know, it is ridiculous to pay students to attend school, but what is your plan to curb the urban male drop-out rate?
[In her comments to this post, Laura noted that Zora Neale Hurston first wrote in Their Eyes Were Watching God, “De nigger woman is de mule uh de world so fur as Ah can see.” I remembered this quote from a televised interview with Alice Walker. Thanks for pointing me to the original source of the quote.]
I never thought I would be so happy to leave the Congo. Goma never felt right to me; in fact, the more days I spent walking along the dark gray lava-covered ground, being stared at by suspicious and glaring eyes, the more tense and anxious I became. Like Will, I was relieved to return to the oasis of our hotel every night.
Others in the Congo do not have the choice to leave. I keep thinking of the camps I visited full of homeless people living in thatch-roof shacks. One camp is aptly nicknamed “misery camp”: Many have had family members raped and killed, they have no access to education, and they are completely dependent on outside assistance for food. These villagers cannot return home. They have no security anywhere. They are indefinitely stuck in these tiny camps, with uncertain futures and little hope.
“Misery camp” may well reflect the status of the Congo. It’s infinitely sad to me that such a beautiful country endowed with so many natural resources can have such a tortured past and present. I remember driving through a town in Rutshuru province that was absolutely breathtaking, with beautiful greenery and lush vegetation everywhere. No more than 5 km from that town, we came across another one where its crops were neglected and houses burned. Weeds were growing everywhere. This town had been attacked by soldiers, our guide explained. All the people have left and are now living in a displacement camp. Like its crops, the town is completely deserted.
What’s ironic is that the villagers who left are now dependent on the food provided by the World Food Program (WFP), whereas before the attack, the town used to produce food for the WFP. Who attacked the town remains unclear: one rebel fraction will always blame another, and all will say that whatever they did was justified to bring peace to the people. “I don’t think these soldiers understand,” said our guide, “They say they are fighting for the people, but they are actually shooting the people in the head and our country in the foot.”
The most bizarre experience on this trip so far has been the visit to General Laurent Nkunda. It’s hardly an everyday occurrence to go to the military camp of an actual “warlord” who is accused of raping and massacring thousands. (He prefers to be referred to as “liberator of the people”, and denies all allegations against him.) That a journalist well known for opposing him had just been assassinated in the Congo, and that General Nkunda made several references to our security, made us apprehensive during the interview and cautious in subsequent reporting.
One of the most striking parts of the interview is the religious fervor with which General Nkunda led his troops. Apparently, he is very influenced by the evangelist movement, and as a pastor in the Pentecostal church, he helps to convert and baptize his troops. He proudly sported a pin, “Rebels for Christ.” Before each drink and meal, he and his faithful prayed. “We fight in the name of the Lord,” he told us. “That is what I tell all my troops. When they fight, they have God on their side.”
As a lapsed Christian, I have to admit that I don’t know much about Christianity. But something about Nkunda’s comments made me feel ill to my stomach. Was he really using God as a license to kill? Was it really his conviction that God was with him in battle, or was he using “the God card” as a way to manipulate and control his troops? It would not be the first time that the name of God has been used to consolidate power, and certainly not the first time religion has given hope and purpose to unemployed young men without good futures.
I spoke with another pastor in the Pentecostal church about my discomfort. This pastor lives quite a different life from Gen. Nkunda: Reverend Samuel Meyele is one of the pastors working for HEAL Africa hospital who counsels women victims of sexual violence. There are no international warrants out for his arrest, only international praise.
According to Pastor Samuel, Nkunda’s faith at one point seemed real. Pastor Samuel recalls when Nkunda first joined a neighboring Pentecostal church in Goma. He and Nkunda were even friends at one point. When Nkunda first started leading his troops into war, Pastor Samuel said that none of the local churches would believe it. They were finally convinced that he was the one leading the crimes and atrocities, and his own church ended up excommunicating him. “What he does now, it is not part of the church. It is not right. He can call himself Pastor and Pentecostal, but this is not what we believe.”
I can hear the music pulsating in the thick Congo night, inviting me. “Come over, dance, drink, have a good time, enjoy life.” But I am scared to leave the hotel at night.
The breaking news is just over those mountains, the stories that will bring attention to the horrific conflicts of the Congo. But I am too scared to go. There is fighting in the hills, and everyone says the soldiers on both sides are immoral, unpredictable and without remorse.
It is terrible to feel such fear, it shakes you to the core. It controls your days and your nights, your security, your freedoms, and even seeps into your dreams. I do not have to live in such fear; in one week I can go home. But such is life in parts of the Democratic Republic of the Congo, where various conflicts have killed four million people and displaced one-and-a-half million more since 1998.
Imagine living in a rural community where your daughter could be raped, or even sodomized, by soldiers every time she leaves home. Recently, Nick Kristof asked a village leader to speak with a woman who had been raped, and the line continued to grow and grow at a sickening rate.
Imagine living in a rural community where you do not grow crops to feed your family, because the soldiers will simply eat all the fruits of your labor anyway. Imagine hiding the fact that you have a job, because the soldiers will ransack your house first. Imagine leaving your village and home with your family in the dark of night for places unknown, because the soldiers’ violence devours everything in its path.
The gripping control of fear is not exclusive to the Congo. I know families in Chicago who do not let their kids outside to play. I have seen children scatter when it was only a car backfiring. I have taught high school gang members who know any day could also be their last day.
People do not appreciate security until they experience fear. Fear is so encompassing that it can become a person’s driving force. It is ludicrous to expect a person, community or even a nation to prosper and progress when they are in the throes of instability, insecurity and fear. Basic human rights like education, health, liberty, etc. cannot be developed and obtained until security is established, whether it be in the Congo or in Chicago.
We went back to HEAL Africa to visit Yohanita, the 41-year old woman we had found in the village of Malehe to be suffering from infection and severe malnutrition. I was relieved to see that she was lying in bed, fully conscious, and able to speak in full sentences. Feza, the girl who came down from the village, was at her bedside and feeding her some porridge and potatoes, which Yohanita was eating in big spoonfuls.
“How are you?” I asked Yohanita. She responded that she is fine. She misses her family, but said that she is glad to be in the hospital and eating.
Yohanita’s fever was done. Since she was severely dehydrated, she is continuing to receive saline by IV. She is also being treated with antibiotics for her bedsores. The plan is to continue the refeeding and wound care, and to address any other underlying problems that may complicate her recovery. She will probably remain at the hospital for a month, possibly longer, to get her nutritional status back in order and her wounds tended to.
Through a translator, we found out more about Yohanita’s story. Some time late last year or early this year, she had a miscarriage. In March, she fell and probably fractured her pelvis. Because she had spent the family’s money on her last hospital stay, there was no money left to send her to the hospital this time. She could not move, and for three months, had been lying in her home in terrible pain. The bedsores are a result of her immobility. At the same time, she has not been eating because the family had no food, and since the villagers had similar problems, the family has not had help. Yohanita’s rapid deterioration is likely a combination of immobility and starvation.
As Yohanita’s story unfolded, our translator, a man my age named Patient, burst into tears and left the room. Outside, he told me that seeing Yohanita reminded him of so many people he knew who were in the same plight.
“The soldiers go, but they take all your things, and then you have no money, no food, no house,” he said. “And they rape you and kill your family. Then they might come back tomorrow, the next day, the next week, and do it all over again. Things are just like this. There are no more human values in this country.”
Not everyone approved when we took Yohanita, a severely malnourished woman, from her village to the hospital. Dr. Lisa Dillabaugh, a Pediatrics resident, posted an opposing view:
“…It is so natural for a doctor to feel the immediate need to intervene when seeing someone so ill, but this need to intervene is the reflection of your Western medical education…. It is so important to also consider what your actions will affect in the long run.
While this woman may very well recover in the hospital, she may also die there away from her family and community. Did she actually want to go an hour away from her home with a neighbor? If the community was reluctant for her to go, what happens if she dies there? Will they think hospitals are a place you go to die and be reluctant to allow others to follow.…
But probably most importantly, that community still has no medical care and no transport and no empowerment to change it. All they have are caring, but transient muzungus who dropped in and helped one and left the others. I truly believe this is always the wrong approach and that as physicians committed to improving global health we have to empower people to improve their health, not save them.”
I disagree with Dr. Dillabaugh, but she raises two important points. First, is it appropriate to impose our values on Yohanita and treat her? Second, even if we helped her, there are still larger problems in the community, and many others are left ill and in need.
Regarding the first point, I agree that to simply whisk Yohanita away in a car while her parents and neighbors opposed the treatment would be akin to kidnapping. However, that’s not what happened.
Her parents were initially reluctant, and her fellow villagers had doubts, for good reason: they didn’t know if her condition was really that serious, and they hadn’t had the means to pay for her care. Once we explained the gravity of the situation, and helped them overcome the barriers to her care, they were glad to have her be treated. Most importantly, Yohanita herself consented to the treatment. The warm reception we received when we went back to Malehe to update her parents on Yohanita’s condition gave me confidence that we did right by her family.
Today we visited Jomba, a town that was attacked by rebel soldiers about a month ago. A local priest was killed during the attacks, and the villagers left and recently returned.
We talked to a teacher at the religious school. There were children running around outside the school, and as usual, once they saw the “muzungus” (white people), especially muzungus with lots of camera equipment, they came flocking over. “How do you feel about the future?” I asked him, leaving the question deliberately vague. “Il n’y a pas d’espoir,” he responded (there is no hope). “I do not have hope for these children. We don’t even know when is the next time we will be attacked. We do not know if we will be living tomorrow. How can we think about the future?”
It was striking that many villagers we’ve spoken to have said that life was better before. A 21-year-old father of three told us that he thought his grandfather’s life is better than his life now. A principal of a school told us that he liked life better under the despotic rule of Mobutu than now, “At least there was security then, and people were not always worrying about being raped and killed.”
Aya Shneerson, the World Food Program provincial director who accompanied us to Jomba, related another story that illustrated to her just how bad the situation in the Congo was getting.
When she was visiting a village with a foreign dignitary, an elderly woman came up to them and begged. “Please colonize us,” she said. Both Aya and her visitor were aghast that someone could think that the colonial days were better, especially since the Belgians had such an atrocious history in the Congo. Yet, this is how bad things had become.
How is it possible that the situation has gotten so bad that people wish for the past, and not for idyllic good times, but for pasts dominated by corrupt leaders who exploit the local population, and neglect heir people while amassing treasure troves of billions? Right now, the people’s needs are not just neglected—their everyday life is threatened. Recall Maslow’s hierarchy. A person needs to have the most basic needs fulfilled, like food and shelter, before they can think about other needs. In this case, a basic level of security needs to be in place before people can even start thinking about health and education. Without the security, daily existence is tenuous. Il n’y a pas d’espoir. There is no hope.
What is life like on Win-a-Trip? Will and I had asked Nick on the plane ride here about free time. Nick responded, “What free time? We work all day and write all night.”
He wasn’t kidding. The days are the long, the work hard, but the experiences exhilarating. We get up around 7AM, head off to the first of several locations, then come back around dark. With the exception of the time when we were in the hands of General Nkunda’s rebels, locally-based aid workers serve as our guides, interpreters, and drivers. Because we do not want to depend on neighboring Lake Kivu for hydration, we buy bottled water. Food is whatever is available; for the last several days, we have been eating the same stale bread, little bananas, and rubbery mushrooms from the in-house restaurant.
Will and I divided up the responsibilities so that one of us would be blogging about the day and the other working on a video with Naka Nathaniel, our resident videographer guru (if you have not yet, make sure to watch Naka’s amazing videos of our trip). The person blogging writes an entry and works on editing it with Nick. The person doing the video works with Naka to figure out the angle of the video and records a voiceover to accompany Naka’s footage. True to our personalities, I always write a script, while Will spontaneously talks about the day. Blogs and videos are posted through a satellite phone. We also spend some time in the evening debriefing with the documentary film crew that’s following us around.
But what’s life really like? What do we really do? This morning we left at 7:30 with the World Food Programme (WFP). Our guide of the day was Aya Shneerson, a strong and sharp-tongued North Kivu WFP director. We accompanied Aya to a town about two hours away where the WFP was starting a food assessment. Last month, a priest was killed in the church by soldiers. We had to have a military escort for the last 20 minutes or so to Jomba, and were accompanied by the blue hats of MONUC, the U.N. peacekeeping mission to the Congo.
Will Okun has taught English and photography for eight years at Westside Alternative High School in the Austin community of Chicago. He is also the sponsor of the weightlifting club and, at 5' 5" (in boots), claims to still be the best basketball player in the school (unconfirmed). Will spends the rest of his waking hours operating wjzo.com, a Web site that features his portraits of high school students and documentary photographs of the West Side communities of Chicago. The site offers a unique perspective on inner-city youth culture and averages 30,000 views a week from all over the world. Will proudly hails from Carrboro, North Carolina.
Leana S. Wen was born in Shanghai, China. She came to the U.S. on political asylum in 1991, and grew up in Utah, California and Missouri. Her experiences as an immigrant in diverse communities are driving forces behind her interests in public health and international health policy, and her commitment to fighting for social justice around the world. A recent graduate of Washington University School of Medicine, Leana has served as a Global Health Fellow at the World Health Organization in Geneva; as a National Security Education Program Boren Fellow in Kigali, Rwanda; and as National President of the American Medical Student Association, the nation's largest independent organization of physicians-in-training. Leana is a Rhodes Scholar-elect, and in the fall, she will begin two years of study at the University of Oxford to examine health systems in developing countries. After her return, Leana plans to enter residency training in emergency medicine.