Glimmers of Hope Amid Horror for Some Rwandans

Foaming at the mouth and panting, the parched and emaciated boy lay on an olive-drab stretcher, the body inside his yellow-and-red T-shirt wasted down to the size of a healthy 2-year-old.

Cpl. Kevin Kus, 37, held a thick syringe of solution of rehydration salts in his hands, squeezing it drip by drip into the clear plastic tube that led into the boy’s nose.

A father himself, the small, stocky soldier from Sheffield, England, was stunned at how small the 5-year-old Rwandan had become.

“I’ve got a son that age myself,” the gentle Yorkshireman said.

These days, attention may have turned largely to other, more immediate crisis situations, such as those in Cuba and Haiti.

But sickness, suffering and death continue in Rwanda and in the crowded refugee camps now sprinkled outside this Central African nation’s borders.

Now, though, there is also life and recovery in some places, as large-scale international efforts continue to stitch together a new health care network to care for those who have survived ethnic massacre, civil war and days or weeks of panicked wandering as refugees.

“The high emergency, I think we today can say, is under control,” James P. Grant, executive director of the United Nations Children’s Fund, said as he ended a visit to Rwanda.

Enormous problems remain, the American U.N. official readily acknowledged, especially in the camps in Zaire, where more than 1 million Rwandans in exile have packed together in horrible conditions and where a cholera epidemic had flared but waned by last month.

But it is now time, UNICEF’s director said, “to look at how to get the process of normality, the systems, going.”

In part, that means to rebuild a crippled country’s ability to treat its sick and keep everyone else in good health.

In a schoolhouse of honey-hued brick in this dusty, ramshackle town near Rwanda’s southern border, a British medical team has set up shop to help deal with the needs of 60,000 people who hurriedly left their homes and now sleep restlessly on the hillsides beneath sheets of green plastic, not knowing whether they can ever go back.

“You feel good, and you feel very frustrated because there’s so much that you can’t do,” said Sgt. Rich Richardson, 34, of Kent.

Refugees with gaping slashes from machete wounds, unattended babies who have stumbled into cooking fires or pots of boiling water at the camp and cattle poachers with gunshot wounds, have been brought in to be cared for by the British doctors and medics.

“You get a pay-back. It’s treating sick people instead of people who whine,” said Eddie Chaloner, 30, a junior surgeon in the Territorial Army, Britain’s equivalent of the National Guard, who recently wrapped up a six-month stint at London’s St. Bartholomew’s Hospital.

Now Chaloner makes his rounds here in a green T-shirt with an SA-80 automatic rifle slung over one shoulder and a stethoscope over the other.

Some Rwandans are in great need. Others are past all help.

This week in a former classroom now lined with a score of field stretchers and beds, a 20-year-old woman whose card gave her name only as Niyongagina lay quaking with fever under a gray-brown blanket. Infected with the region’s most dangerous strain of malaria, her dark eyes coated with a filmy glaze, she trembled so hard that her metal-framed bed shook.

“That one’s already knocking at death’s door,” said Lee Harrop, 23, a thick-armed combat medical technician from Kent.

It was shortly after 1 p.m. The bodies of two children, one who succumbed to meningitis, the other to malnutrition, had been carried out by orderlies that day.

On average, 450 Rwandans, some hobbling weakly on staves, others carrying desperately thin children, line up each day outside the school to be treated by the Britons, who have been in Rwanda since Aug. 2. Most just need what is known as “oral rehydration.”

Under awnings made from plastic sheeting, they come to sit out of the sun on three rows of benches and drink from canteen cups filled with a solution of electrolyte powder, which will replenish the natural salts that their bodies have lost through stress or malnutrition.

Many of these Rwandans appear disoriented and numbed by the near-hell that their lives have become. The children stare empty-eyed, not bothering to brush away flies that light on their faces.

In another classroom, where young paratroopers work to cassettes of Mariah Carey or the Brand New Heavies, more serious cases are given fluids intravenously, or like the emaciated 5-year-old Kus was caring for, by nasal-gastric drip.

Small infants have a special need: Many are now too weak to suckle at their mother’s breast, or their mothers, exhausted by flight and the privations of life in the camps, have stopped lactating.

In the Rwandans’ often unforgiving struggle to survive, cases like these--the young or the weak--can lose out.

“You can put a blanket on one of them, and you come back the next day, and the blanket is gone,” Lance Cpl. Danny Dixbury said.

British soldiers have been posted at the entrance to the schoolyard to keep order, because stronger, healthier refugees were often pushing the very sick or young to the back of the line.

About a third of the Rwandans treated are HIV-positive, mirroring the ravages of AIDS in this landlocked region just south of the Equator. As a precaution, the Britons wear white plastic gloves.

At least 35 patients have died in treatment. But once or twice a day, on a metal table equipped with gynecological stirrups, babies are also delivered in the school-turned-hospital, at a ratio of two live births to each stillbirth.

In this town in Rwanda’s southwest, where the French in June created a sanctuary for fleeing refugees, causing an estimated half a million people to flood in, the tasks performed by the Britons indicate on a small scale how much must be done to heal a country mauled by massacre and war.

Royal Engineers in T-shirts, their faces yellow-brown with dust, are repairing the culverts on the rutted, unpaved road that links Kibeho with the city of Gikongoro to the north, so the lifeline for relief supplies to the refugees will not be washed out in the coming rainy reason.

To stave off the threat of dysentery in the camps, Capt. David Micciche of the Royal Army Medical Corps is directing a nine-member team helping supply the refugees with clean drinking water. The only available raw water source at the moment is a dirty hillside creek.

The captain and his men can supply 18,000 liters, or about the same number of quarts, of treated water a day--a tumblerful or so for each refugee. But Micciche has just received two 10,000-liter tanks designed to filter out sediment, and he said production should soon increase to about 50,000 liters.

On a countrywide basis, UNICEF’s Grant said his agency, as part of a $55-million emergency aid program, plans to help get 150 of the 350 health centers that Rwanda had in operation before the war up and running again by the end of the year. The French medical assistance group Doctors Without Borders is taking charge of 30 others, he said.

“At present, the central medical stores are being stocked,” an upbeat Grant told a weekend news conference in Kigali, Rwanda’s capital. “We expect that by the end of September, the basic essential drugs system of the country will be at normal.”

It is obvious, though, that Rwanda will require long-term, lavish assistance in rebuilding its health care network, because so many doctors and nurses died in the massacres in April and May, while many others fled over the border with the other refugees.

The British hope to be out of Kibeho by Christmas.

“But things could happen,” Richardson admitted.

It is not clear who would replace the Britons, who complain that the Rwandan nurses who work the night shift are so lackadaisical that they do not change the intravenous drip bottles, causing the tubes stuck into patients’ veins to clog.

Because of overcrowding in the camps, Chaloner said outbreaks of pneumonia, measles and meningitis among their 60,000 occupants are possible.

Unless a supply of clean water and latrines for the sanitary disposal of human waste are soon in place, the looming rains could also bring dysentery and a host of other health problems, along with the ever-present threat of mosquito-borne malaria.

Another consideration is the emotional state of the helpers themselves.

Worried that witnessing so much suffering and death might disturb the soldiers, British generals sent along a military psychiatrist, Maj. Ian Palmer, to keep an eye on the troops.

Palmer said those concerns, so far, have been unfounded.

What has surprised the British, he said, is the quiet stoicism of many of the Rwandans and their capacity to bear pain.

“We see a lot of death in kids and so forth,” Palmer, 40, explained. “I think most of the soldiers expect more grief and anger. It’s certainly there. But the parents won’t show it. We’ve had people come in with mine wounds--in England, they’d be screaming. Here, they just bear it.”