The Doctor is Out

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The slimy mud road to Byumba cuts for miles through the exquisite greens of the terraced, conical Rwandan hills, perpetually topped with black storm clouds in the rainy season. Suddenly, the hospital van pulls onto a side road at the edge of a village; the rear and side doors spring open, a table slides out the back, and staff quickly assume their rehearsed positions. The lame and the halt form a queue behind the van. The first MSF assistant checks for fever by touching each face and chest; an aide hands out oral rehydrants to those who need them. Others await bandaging or a medical interview by the side of the van. Indifferent to the mud and omnipresent rain, Julie and her assistant prepare gauze bandages and antiseptic, watch for symptoms of cholera and malaria. They are utterly focused: There is silence, a calm fusion between medical worker and patient.

We spend the night at a gracious colonial MSF compound, where MSF newcomers brace themselves to meet increasing numbers of refugees. The tension mounts; people fear that the crisis may be too much to handle. Eighteen medical and administrative people will arrive in the next 24 hours; they will need food, mattresses, medical supplies, and instructions. The day after, 19 more will arrive as MSF mobilizes fully for the 1996 Rwandan emergency, dragging European and Canadian volunteers out of comfortable homes and aboard any air transport they can commandeer--23 physicians, 26 nurses, 29 logisticians, 15 water and sanitation experts, 19 administrators, 2 psychologists, and 2 epidemiologists, 116 volunteers in all.

The current best guess is that half a million 'returnees' have crossed the Zaire-Rwanda border and are heading south toward us. Many wonder aloud if the returnees will bring the dreaded cholera with them, and if we are in for a repeat of 1994, when--in what has come to be called 'the Judgment' for the nation's butchery--Rwandans began to sicken with cholera and to die.

The following morning, we return to the capital to find the emergency team house in chaos. Six Belgian and French MSFers, two Scandinavians, and a Canadian have arrived, exhausted and frustrated. They flew all night from Norway on a Ukrainian-crewed Ilyushin transport plane, its cargo bay stuffed with aid supplies; they slept on a bed of high-protein biscuits and urinated in Coca-Cola bottles.

Here in Kigali, those who have worked together on previous postings recognize each other as old friends. Amidst much hugging and squeals of delight, they grab foam mats and unload their possessions, including gifts of European cheeses, breads, and salamis. Those who plan ahead will briefly scrub their bodies under a cold shower. Together they boisterously depart for a restaurant meal on what will surely be their last free evening for many weeks. The next morning, some will notice that the cheeses are writhing with maggots, their fecundity inspired by the African heat. A press officer laughs. They have a sharp and bitter taste, these maggots.

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