work, while others raised money back in the United States. As for the villagers, Deo often said they were
what kept him going—their misery on the one hand, and their wild enthusiasm on the other.
He had established a committee of villagers and given them a real say in the affairs of the clinic. Women
and children were the majority in the community, so he figured that women, and through them children,
should hold the majority in the committee. But the men dominated the meetings anyway. So, over
vehement protests from the men, he abolished that committee and created a women’s committee and a
men’s committee, and since then the women had taken over. It wasn’t as if many men didn’t pitch in, but
it was the women’s committee that mainly organized volunteer work crews, advised Deo on the village’s
needs and desires, and, perhaps most important, managed relations between the clinic and the village.
When one of the soldiers guarding the clinic remarked, “We don’t have much to do,” Deo figured this
was mainly thanks to the women. They had worked hard from the start, he told me. “But now they get to
talk, too, and direct the clinic.” The women made up a song that the volunteer work crews would sing as
they weeded the lawn and tended the gardens that were spreading all around the new buildings. The
song went like this: “This project was brought here by Jesus Christ. We are thrilled. This project is
beautiful. This place is beautiful. Kayanza is beautiful.”
Speaking at a fund-raiser in New York, Deo told this story: “This past summer, we needed some help to
make a road that goes to our site passable. A friend of mine told me, ‘Well, Deo, there’s a great Belgian
construction company that builds roads in Burundi and Rwanda and the Congo,’ and I was so excited.
So I went to talk to the representative of the company. He sent someone to look at the road and
estimated a cost of at least fifty thousand U.S. dollars. Not to pave the road, but just to widen it and
make it passable. I went back frustrated, wondering how to tell the Kayanza community this bad news.
As I was explaining this to them, one woman with a baby crying on her back said to me, ‘You will not
pay a penny for this road. We become so much sick because we are poor, but we are not poor because
we are lazy. We will work on this road with our own hands.’ The next day a hundred sixty-six people
showed up with pickaxes, hoes, machetes, and other tools. One of the volunteers was a woman who
came to work with a sick child. When a friend of mine and I looked at the baby, we saw that the baby
was sweating. I then asked the mother why she came to work with a child that sick. And she said to me,
‘Well, I’ve already lost three children, and I know this one is next, whether I stay at home or come to
work here. So it’s better for me to join others and make my contribution, which hopefully will help to
save someone else’s child, who will be sick but alive when you have a clinic in Kayanza.’
“The entire road, six kilometers long, was rebuilt by these people with machetes and hoes. The same day
the road was finished, the representative of the Belgian road construction company called me to
negotiate the price. You can imagine how I felt to get that call from him. I said to him, ‘Thank you so
much for your call, but it’s already done.’ He was obviously shocked and said to me, ‘What do you
mean? Who did it? We are the only road construction company in the entire region!’ And I said, ‘Not
anymore.’”
At the same fund-raiser Deo compared Kayanza to “a small sunflower seed, no bigger than the tip of my
finger.” He went on, “But the sunflower seed, as everyone will tell you, has the potential to grow into an
enormous flower that is bigger and taller than any of us here.” He imagined the spread of this enterprise,
of a close alliance with the Ministry of Health, of an expansion to the large, underfunded district
hospitals where someday indigent patients would no longer be detained. For the time being, though, the
medical staff at Kayanza was obliged to sleep on the floor of the storage building.
But by November 7, 2007, when the clinic opened for patients, there were three buildings ready for use
and a moderately well-stocked pharmacy. The pastor from Rukomo had objected to the clinic’s tapping
the water pipe that ran from the mountains and through Kayanza, but the government had overruled him.
Water now flowed into a brand-new, fifty-thousand-liter tank with its own internal filtration, enough to
provide safe water for most of Kayanza and some of Rukomo. An African-American doctor named
Dziwe Ntaba, an old friend of Deo’s, left his job in New Jersey and came to work full-time and for no
pay at the clinic. For the foreseeable future the whole operation would depend on private donations—but
by the winter of 2008 no longer entirely on flashlights. Paul Farmer asked a nonprofit organization
called the Solar Electric Light Fund to take on Kayanza, and SELF found a donor named Lekha Singh,
who gave the money to buy a generator and fuel for the time being, and also the money for a solar-
powered, ten-kilowatt electrical system, to be installed by the summer of 2009. A company named
Sonosite donated most of the cost of a compact, versatile imaging machine. Paul English, the founder of
Kayak.com, provided computers and a satellite system so that Kayanza could manage its medical
records and communicate with the rest of the world. And Paul Farmer persuaded national and
international health authorities to make the clinic eligible for inexpensive supplies and drugs, including
free medicines for AIDS and tuberculosis.
By the summer of 2008, Village Health Works had begun administering AIDS medications to fifty-seven
patients. The clinic had an ambulance, beds for ten patients, and thirty-three community health workers.
It had a growing vaccination program, a deworming program, and a program to curb malnutrition. It had
six Burundian nurses and a Burundian doctor, as well as Deo’s American medical friends, and it had a
new building for all of them to sleep in, in beds. The clinic was receiving an average of forty-seven
patients a day, and sometimes as many as ninety—about twenty thousand individual patients in its first
year. They came on foot and in the baskets that serve traditionally as stretchers—one man, near death,
was brought encased in a bag, ingeniously strapped to a platform, itself ingeniously attached to the back
of a bicycle.
Everyone who made it to Kayanza was seen for free, by a doctor or nurse. All were asked to pay for
their medicines, if they could. Not always, but often, it was the best-dressed people, even people who
drove up in their own vehicles, who claimed they couldn’t pay. The staff usually sent those people off
with only a prescription, to fill elsewhere. The staff had lists of the poorest people in the area, and it
wasn’t hard for Deo to spot the others who were truly destitute, as he circulated among the crowds that
gathered outside the clinic every morning. It seemed as if the poorest were often the ones who would
insist on paying for medicine, the ones to whom he and the staff would say, “No, no, go and buy some
beans instead.”
Some patients traveled long distances on foot, usually in groups, some even from Tanzania, and some
crossed the lake from the Congo and hiked up to Kayanza. Deo always asked these people, “How did
you hear about us?” The usual answer was a phrase that meant literally, “When you’re miserable, you
lose your head.” That is, a person in misery forgets to be silent and talks to everyone. Because those
patients had long return journeys, it was decided that they would be seen first in the mornings. The
women’s committee joined in creating this policy, and when some of the villagers objected, it was the
women’s committee who explained and calmed them down.
Some people visited not for medical help, but only to look at the clinic. When Deo asked one of these
travelers why he had come, the man replied, “To see America.”
This made Deo happy, since he was a full-fledged American now. But other testimonials seemed more
important. For instance, from a driver who, Deo believed, was a former Hutu militiaman. After making a
few trips to the construction site, the man came up to Deo and said he was puzzled. Ninety-nine percent
of Kayanza was Hutu, but Deo was a Tutsi, wasn’t he? Told this was true, the driver walked off literally
scratching his head. The next time he arrived, he volunteered to help out with the planting at the site.
One elderly patient told Deo that he’d been fighting and killing Tutsis ever since 1965. The man had
scars all over his body to prove it. He told Deo, “I wish I had spent my life trying to do something like
this.” He was already getting free care and medicine. So Deo figured his words were at least partly
sincere. He said to Deo, “If I could prolong my life, I would do nothing but work with you guys.”
A lot of people in Kayanza, it seemed, were astonished by Deo. One villager said, “Many others went
abroad, but most of them have not returned to show us how we can improve our situation. We have
never seen before an educated man like him hiking around in the mountains, up and down, to talk with
people in their households. When we are working, he does not cross his arms. He works with us, so that
the work can be done quickly. We hope that other people will see how he behaves, and then imitate
him.”
One day a woman approached Deo with her head bowed and said, “You don’t know me, but I want to
say that I am so sorry for what happened.” Deo suspected that she was confessing to some offense
against his family during the war. Her words worried him. If people thought he planned revenge, they
might try to kill him first. But it seemed to Deo that Kayanza was becoming a “neutral ground,” a place
where Tutsis from the mountains and Hutus from the lakeside could mingle without fear. A place of
reconciliation for everyone, including him. And he hoped he wasn’t dreaming. “What happened
happened,” Deo said to the woman. “Let’s work on the clinic. Let’s put this tragedy behind us, because
remembering is not going to benefit anyone.”
BURUNDI, JUNE 2006
As we drove through southwestern Burundi, I felt as if we were being followed by the mountain called
Ganza, the way a child feels followed by the moon. The road climbed through deeply folded
countryside. We would round a corner, and another broad face of Ganza would appear.
Then my companion, Deogratias, would order the driver to stop. Deo would get out of the SUV and
stand on the shoulder of the pavement, aiming his digital camera at the mountain. Deo wore a black bush
hat with a dangling chin strap. I supposed that to people passing by, in the crowded minibuses and on the
bicycles laden with plastic jugs of palm oil, he must look like a tourist, a trim young black-skinned rich
man from somewhere far away.
Standing beside him at the roadside, I could look down on narrow valleys of cultivated fields and up at
steep hillsides, some covered with grass, others quilted with groves of eucalyptus and banana trees and
dotted with tiny houses roofed in metal or thatch. Above them rose the flanks and the domed top of
Ganza, all but treeless, barren of houses. In Kirundi, ganza means “to reign,” and the name evoked the
kings that once ruled Burundi. The little nation, centuries old, straddles the crest of the watershed of the
Congo and Nile rivers, just south of the equator in East Central Africa. It is bordered by Tanzania to the
south and east, by the Democratic Republic of the Congo across Lake Tanganikya to the west, and by
Rwanda to the north. It’s a landlocked and impoverished country with an agrarian economy that exports
excellent coffee and tea and not much else—a land of dwindling forests that still has lovely rustic
landscapes.
Deo could hardly take his eyes off Ganza. He was thronged by memories. All the summers of his
boyhood, once a week and sometimes twice, he and his older brother had toiled over the mountain,
climbing impossibly steep paths, their knees shaking under the loads balanced on their heads. Back then,
the land out there had all been thickly forested, and in the trees and under them he used to see chimps,
monkeys, even gorillas. They were all gone now, he said. But there had been so many monkeys then!
One time he and his brother sat down to rest partway up another mountain, and a host of monkeys
surrounded them, like a gang of little thugs, harassing them, trying to take their sacks of cassava, even
slapping them right in their faces! In the end there was nothing for him and his brother to do but run
away, leaving the cassava behind.
When he told me this story, Deo laughed. It was what I’d come to recognize as his normal laugh. It had
the same bright, surprised, near soprano sound as his voice when he greeted a friend and cried out,
“Hi!,” the “Hi!” drawn out as if he didn’t want it to end. His English was accented with French and
Kirundi and sprinkled with misplaced emphases—as in, “I am laughing when I think about it.” And
many of his phrases had a certain hybrid vigor, a fresh extravagance: “I want to get it out of my chest.”
“Run like a thunderstorm.” “I had to bite my heart.”
Deo grew up in the mountains east of Ganza, in a tiny settlement of farms and pastures called Butanza.
He had returned to Burundi several times over the past six years. But he had avoided Butanza. He had
not visited it for nearly fourteen years. Now he was going back at last. He seemed happy to see Ganza
again, but when we drove farther east toward Butanza, he grew, not silent, but increasingly quiet. One
noticed this, because he was usually so talkative and animated.
After a while we turned off the paved road onto dirt roads. The dirt roads grew narrower. Finally, as we
bumped along up a steep, rutted track, Deo said we were getting close. He said that when we arrived, we
would climb on foot to the pasture where, many years ago, his best friend, Clovis, took sick. We would
visit the very spot, he said. Then he added, “And when we get to Butanza we don’t talk about Clovis.”
“Why?”
“Because people don’t talk about people who died. By their names, anyways. They call it gusimbura. If
for example you say, ‘Oh, your granddad,’ and you say his name to people, they say you gusimbura
