We walked over to the university hospital, the teaching hospital. I could imagine Deo in a white coat, a
student on rounds. As we passed through the rooms, rooms that used to contain only two beds but now
had six crowded together, he smiled at patients, offering greetings to each. He stopped at the bed of a
young woman. A plaster cast covered one of her legs, from toes to hip. He asked her for her story. She
said she’d been tending her bean plants in her roadside garden and had been hit by a passing car, which
hadn’t stopped. Kindly neighbors had brought her here, but she had spent her life savings, such as they
were, for her medical care, such as it had been, and was now in debt.
That woman, Deo said as we walked away, would soon be discharged to a special section of the hospital,
equipped with security guards. She would be prevented from leaving until someone paid her bill, and in
the meantime would receive no nursing and not even food, unless a friend or relative brought some to
her. That was how the medical system dealt with unpaid bills these days.
Detention of indigent patients—imprisonment, really—wasn’t exactly the fault of the new Hutu-led
government. Given time, perhaps, the new administration would end the practice, which had begun
under the previous, mainly Tutsi government. The World Bank and other international financial
institutions had insisted, as they had through much of Africa, that Burundi’s medical facilities impose
“user fees.” Some time back, in its zeal to collect those fees, this very hospital, the place where Deo had
trained, applied the policy to corpses. The authorities refused to release the bodies of people who died
with unpaid bills. Deo had heard the rest of the story, and he told it with a certain grim satisfaction. The
morgue was unrefrigerated; when the air in the neighborhood became unbearable, the city’s mayor
ordered the bodies released. The bankrupt patients were buried, Deo had heard, by prisoners who
couldn’t refuse the job.
While visiting hospitals on his last trip to Burundi, Deo had met a total of thirty-eight patients in
detention at two hospitals, and he’d learned of more than a thousand others in different facilities. Of the
detained patients he met, a woman with burns covering half her body stood out for him, as did an elderly
woman with a soulful, mournful face. He photographed that elderly woman, then bailed her out, for
fifty-seven dollars. He had already made an appointment to talk to the minister of health about his plans
for building a clinic. He decided to take the elderly woman along, so she could tell the minister her story.
The security guard outside the minister’s office stopped him. “You can’t bring her in here,” he said.
Deo told the guard that the old woman was the minister’s aunt. “The minister will be so happy to see
her!”
Deo told me, “If I were living in Burundi, they would have sent me the same day to jail.” But the
minister, a woman, did listen. The elderly woman had a beautiful face. In Deo’s photograph of her, I
thought he had captured some of the essence of dignity and sorrow. Maybe the minister saw something
like that as well, in the sad, stoic, weathered face across her desk. At any rate, on the following day, 150
detained patients were released from various hospitals. But the policy remained. Before long, 150 new
sick detainees would replace them, Deo figured. When he got back to the United States, he thought of
trying to raise enough cash to free all the patients, then realized this would only make detentions more
lucrative for hospital administrations. For weeks he stole time from his studies at medical school, trying
to write a paper on the issue, but to his relief he had recently been upstaged by a detailed exposé from
Human Rights Watch.
Many friends and family wondered why Deo kept coming back to Burundi. Many, including his mother,
said they wished he wouldn’t tempt fate in this way. To me, he said, “But it’s my country no matter
what. You know?” And as in almost every setting of great poverty, health in his country was dreadful.
He had gleaned Burundi’s statistics from various sources. These were some he liked to cite at fund-
raisers for his yet to be built clinic: an average life expectancy of about thirty-nine years; one in five
deaths caused by waterborne diseases or lack of sanitation; severe malnutrition for 54 percent of
children under five; for women, a one-in-nine lifetime risk of dying during childbirth; and fewer than
three hundred doctors to serve a population of about seven million. And most of those doctors practiced
in the capital. Many didn’t see patients in public facilities but worked for foreign aid organizations
because the salaries were far better.
I think this was Deo’s favorite part of the tour he led me on, the part that had to do with public health
and medicine. These, I think, were the subjects around which time could reassemble for him, around
which past and present and future could begin to seem coherent and purposeful.
It was on our visit to Sangaza that he began to tell me the story of his first attempt to build a clinic, when
he was a schoolboy years ago. It seemed as if the story all came back to him there at the site of that
attempt—with amusement added, most of the pain of failure withdrawn.
Near the end of his junior year at high school, Deo had said to a bunch of his friends—no doubt one
could have heard his father’s and grandfather’s voices in his—“Instead of wasting time walking around
chins up, why can’t we build a clinic in Sangaza?” “Chins up” was Deo’s term for arrogance; because
places in high school were rare, students tended to lift their chins at the thought of manual labor. He won
over half a dozen friends, and led a small schoolboy delegation to visit the governor of the province. The
governor agreed that if they managed to put up the walls of a clinic, he would supply the metal roofing.
Deo talked his father into giving him a little time away from cowherding duties, and the week after
school let out, Deo and his friends made bricks. Deo persuaded some of the local women to cook meals
for the work crew.
They made a great number of bricks out of wet clay. But they didn’t know how to fire them, and they
had no money to hire someone who did. A thunderstorm turned all their bricks back to mud. Deo
overheard adults talking about “those kids”—kids who didn’t know what they were doing, who were
just wasting time, just trying to avoid their chores at home. He realized he should try to get the
community involved. In the fall of the following year, right before school started, he organized an
election in Sangaza. A clinic-building committee was chosen, another largely student work crew
assembled. They made more bricks, and this time Deo and the committee managed to get a local
craftsman to fire the bricks for a nominal fee. But they had to build a kiln first, and that took many days.
By the time the bricks were being fired, the rains had begun. When the rains ended months later, the tall
pile of partially fired bricks had collapsed, partway back to mud again.
So Deo and his friends decided to build out of wood. The first week of the next summer vacation, they
started cutting trees from the forest next to the graveyard in Sangaza. They cleared a site and carried logs
to it, singing traditional work songs. But they hadn’t cut nearly enough wood to begin construction
before his father’s dispensation ended and Deo had to return to cowherding. He had told himself that he
would get back to building the clinic someday. And now he was—about sixteen years later, and in
Kayanza.
Deo’s impulse to public service had been planted by his mother and shaped by Bishop Bududira; in our
travels in Burundi, Deo made sure to stop at the small memorial to the bishop, adorned with plastic
flowers, in a corner of Bududira’s former church. And Partners In Health had given Deo confidence: no
one could have worked for that organization without believing in the possibility of building public
health systems and hospitals in desperately poor places. When PIH had expanded into Rwanda, Deo had
hoped they’d also go to work in Burundi. But now he knew they wouldn’t, not right away. The
organization was already overextended, with large projects all over the world. He knew that Paul Farmer
hoped he wouldn’t try to build a clinic on his own, at least not before finishing medical school. But he
also knew that if he forced the issue and got a facility started, PIH would help him. Farmer was already
giving him advice and had promised to visit the site later in the summer.
At Partners In Health, I think, Deo had discovered a way to quiet the questions he’d been asking at
Columbia. That is, he saw there might be an answer for what troubled him most about the world, an
answer that lay in his hands, indeed in his memory. You had to do something. And trying again to build a
clinic must also be a way, I thought, for him to reach back to his former life and connect it with his new
one.
We were sitting one night in an outdoor bar, taking a break from touring. As often happened wherever
we were, Deo began talking about his plans for Kayanza. It wasn’t my place to worry, I suppose. But I
did. He didn’t yet have an organization that would finance and construct and staff the clinic he imagined.
In fact, he was still trying to decide on a name. He would come up with one, declare emphatically this
was it, and then for one reason or another reject it. In the bar, he finally settled on “Village Health
Works.” I was glad to have the matter settled—for how long I wasn’t sure.
The night air was fragrant; I smelled jasmine. The third round of beers had arrived at our table. Deo said,
“So my pipe dreams are these. If the Kayanza project is successful, we can expand around, and people
will see, ‘Oh it works, it’s good.’ And hopefully the whole country will begin to understand that you can
do this without bringing a hammer, because once you bring a hammer, people will bring a shield, with
another hammer to break your legs. How can we be healthy and a good society? We can train nurses in
Kayanza and expand all over the country. Let the population know: ‘Look, this is what life is.’ And those
people, they will teach other people, make people see what is right. And show them the value of work.
And that would erase, not the history, but it would create a new world, make it peaceful and a wonderful
paradise. It’s a really small country. There is no reason why it should be impossible, no reason at all.”
He had been smiling, a faraway look on his face. It faded. “I know I have these unrealistic beliefs and
thoughts, that the world can be peaceful, can be healthy, people can be humane. But is it feasible?”
“Well, you won’t know unless you try,” I offered.
“Right. And if you try … Sometimes I think, ‘Am I crazy?’ You try to save someone and you get killed,
by that person. You stay away, you get troubled, because you are not doing something you believe in.”
He laughed. “In the middle of the ocean, and I always have these thoughts. Goddammit!”
“So here we are off to Kayanza!” cried Deo as we turned off the paved highway beside Lake
Tanganyika. A deeply rutted dirt road led through a palm grove, a dark and mysterious maze, orderly,
fecund. There were seven of us crammed into the SUV. Deo’s American medical friends had come with
us on this trip, too. This was what they had traveled to Burundi for, to help him get started on the clinic.
This trip to Kayanza would be the summer’s opening ceremony, as it were. I was looking forward to
seeing Kayanza, Deo’s adopted hometown, which had clearly replaced Butanza in his affections. More
than that, I was looking forward to meeting his parents.
He had told me some of what he knew about their recent past. His father had come all but undone during
their several years as refugees, and the nightmarish years of civil war they endured after returning to
Burundi, and the loss of practically everything they had worked for all their lives, including most of
their cows.
The first time Deo returned to Burundi, on the trip he survived because he didn’t take the bus, he found
his father drinking heavily and threatening suicide. Deo went back to the United States feeling he had to
get his father help. It took a long time, but eventually he made arrangements for his father to see a
psychiatrist, in Rwanda’s central hospital. Deo flew from New York to Kigali to be on hand. But when
he met his mother there, she told him his father would refuse to see him. His father had told her he didn’t
have anything to give Deo. Therefore, he could not see him.
Deo grabbed a bunch of clothes from his suitcase and put them in a plastic bag, which he handed to his
mother. “Just tell him these are clothes you bought for me.”
The ploy worked. His father let him into his hospital room and said, his usual commanding tone restored
for the moment, “I bought clothes for you. Here.” He handed Deo the bag. “Try them on.”
That had been another wretched trip. Deo didn’t even get to Burundi. His uncle said it was too
dangerous, and Deo believed him but also thought, “Too dangerous for me but not for my parents?” And
the psychiatrist wasn’t much help to his father—less help than Deo’s mother, as it turned out. Back in
the United States, Deo heard from relatives that one day, enduring another of his father’s threats of
suicide, his mother had said that if he killed himself, she would follow suit. And it seemed as if his
father awakened at least partially to his old self. In any case, he stopped making the threats.
It was his mother, Deo heard, who had managed almost everything in the years after she and his father
returned from the refugee camps and settled in Kayanza. She milked their few cows and tended the
beans and cooked the meals and took care of Deo’s two youngest brothers. And she managed their
escape, the day when some neighbors warned them that militia were coming. For a time they lived in the
forests near Kayanza. They came back to find their house burned. Deo’s youngest brothers remembered
how anxiously she looked after them, at one point even paying other families in rather distant, safer
villages to take them in. She would walk miles carrying food for the boys, food that the foster families
