The Small Scheme of Life

As a nurse you can end up taking care of anybody. After a prison riot you stitch up the eyebrows of guards and the ears of convicted bank robbers. You give bed baths to senators and kneel to cut the toenails of rapists. And if you really believe that healthcare is a right, not a privilege, you may end up taking care of both the victims and perpetrators of war.

In 1994, I was working as a public health nurse in a refugee camp for Rwandan refugees, which served the Hutus who had crossed into the eastern Congo and killed about 800,000 of their fellow Tutsi countrymen. At the time it was assumed that perhaps 20,000 Hutu had participated in the genocide, and these were included among the million Hutu refugees. No one really knew. I was there working during the shigellosis, cholera, and meningitis epidemics that were exacting a certain revenge on the Hutus. The first day, I counted 2,000 dead bodies.

            This refugee camp, Mugunga, crowded people onto a site on the aptly named Mountains of the Moon as tightly as if all of Seattle had moved their families into plastic pup tents on a few vacant city blocks.

The world here was tilted. Steep slopes bearing banana and papaya trees fell from smoking volcanoes into a huge lake that weeks earlier had been clotted with bodies, and weeks before that had been a water-skiing resort. The first bodies in the waters were Tutsis who had floated from Rwanda after the genocide. Then those disappeared and were replaced by other bodies, Hutus and Congolese who had been stricken by shigella and cholera. Everyone—refugees, genocidists, foreign workers, U.N. forces, and the evil Zairian military in their jaunty red berets—shared, if nothing else, an unsettling concern about the disturbingly active volcano. We all cast an occasional eye on its red glow and ensuing plumes.

We had divided the estimated 300,000 persons in this camp into sections of about 100 households. In my job as the public health coordinator, I walked through each of my sections to check in with my Rwandan staff about the birth and death tolls that we used to see whether the situation was improving or worsening.

To get to Section B, I walked through the narrow spaces that separated the blue plastic sheets that formed shelters. The refugees called these sheetings, which the French aid workers unfailingly corrected to plastiques—as if corruption of the French language were the issue here most at stake.

 I walked between the sheetings and over to Beane, the head worker in Section B. He handed me his tally paper, on which he tracked the day’s events of the 100 families in his section. On the paper were marked the causes of the four deaths: diarrhea, bloody diarrhea, watery diarrhea, and in slanted letters, Tutsi.

“Tutsi?” I asked. He took me over to the exposed body of a woman. Usually families or even strangers wrapped bodies in reed mats or in blankets and laid them out on the side of the road for the cemetery workers to pick up in the daily truck run. Usually only feet stuck out the end. The woman was lying with her arms and legs splayed in an X. Around her was the only open space in the entire camp. It looked as though someone had cut her under her arms with a machete and then pulled until her shoulders had dislocated and she bled out. It was a tilted place... (Excerpt taken from "In the small Scheme of Life,"by Mary Catlin, MPH, BSN. Read her entire compelling story in the book, NURSE BEYOND BORDERS.)