Vacation in Kigali

Every now and then, even though my life isn't particularly "hard" in Kigali, it's nice to take a vacation. The easiest vacation is at the Serena Hotel here in town. Although it's just a few blocks from my house, it's an entirely different world, so once in a while, it's nice to treat ourselves to a lazy day by the pool.

Vegetables!

I finally have vegetables in the garden! They're not quite ready to eat, but they're definitely there. I took my usual series of pictures this week, with each of the beds - radishes, carrots, squash and zucchini, cucumber, spinach and cabbage and tomatoes.
I also took a few close up pictures of everything. There's cabbage:
The spinach looked a lot better before I picked a bunch of it today. I should have taken the picture before instead of after!
I think these plants are cucumbers, but I'm not entirely sure. I guess I'll know once they start blooming.
Lots of baby zucchinis:
And lots of squash, too:
The radishes are also growing well and should be ready before long.

Continued reminders

Even though the genocide has been at the forefront of everyone's mind this week during its annual commemoration, some have had more personal experiences than others. Josh Ruxin, a board member of Orphans of Rwanda, an organization for which two of my closest friends in Rwanda work, who lives here in Kigali, published the following article this week in the New York Times blog. I think it's a pretty incredible reminder of the impact that the genocide still has on everyone here even though it's been fourteen years since it happened.

14 Years Later
by: Josh Ruxin

April 7, 2008, was the 14th anniversary of the commencement of Rwanda’s genocide. With periodic massacres that date back to 1959, Rwanda’s genocide did not happen overnight. Its climax, however, began April 7, 1994. It was a few days later that 36-year-old Epafrodite Rugengamanzi was murdered. From what his sister, Josepha, has gathered, he was chased into the yard of the house where we now live, brutally killed, and buried. Her brother’s killer confessed to the murder during gacaca — the traditional court process for genocide suspects — and brought her to his burial spot.
Josepha came to our house Wednesday with other family members and dug up her brother’s skeleton. The orchestrated process took several hours. Once they were sure that all of his bones had been collected, they carefully cleaned them. Josepha then asked me and my family to come over and listen to their testimony (and asked us to share it with others). Josepha was smiling and told us how lucky she felt to have found her brother’s bones and to be able to re-bury them shortly at Gisozi, the national genocide museum and burial ground.
Epafrodite’s murder was avoidable, since the UN had the power to prevent it. Ultimately it was not an international team of peacekeepers who brought Rwanda’s genocide to a close, but rather, the Rwanda Patriotic Army, a disciplined military force drawn from Rwanda’s diaspora. After years of fighting, the Rwanda Patriotic Army on July 4, 1994, brought stability to the country. Human Rights Watch, a French judge, and a Spanish judge allege, however, that the Rwanda Patriotic Army carried out thousands of reprisal killings and crimes against humanity during and after the genocide. President Kagame publicly bristled this past week over the recent Spanish indictment.

A close look at the complexities of Rwanda’s genocide would remind China’s leader Hu Jintao, President Bush and others of the path history can take, yet does not have to. Darfur is at least beginning to take on some of the dimensions of Rwanda: a gradual genocide in a region still lacking an adequate peacekeeping force and the political commitment to bring it to an end. The carnage there continues and now a new genocide threatens in Southern Sudan. While hope has so far proven elusive for Sudan, it is even harder to imagine that its people will get themselves on Rwanda’s track to peace and prosperity anytime in the next few decades. Rwanda’s resilience and approach are exceptional.

My friend and head of Orphans of Rwanda, Jean Baptiste Ntakirutimana, wrote me the other day about his meeting last week with his mother’s killer: “I inquired first about his life in prison, his family and his state of mind. He said he was expecting that I could kill him, which he thinks was the way of doing justice for having killed my mum. He added that no one dared killing my mum; that she was brought by two militia to her home village and called for people to come and kill her. No one did so besides him who felt he had to kill her. In fact he told us that they were told that no one was allowed to loot from Tutsis before killing all their family members. Since they thought I was already killed from Kigali, where I was residing, the only hindrance to take all the family property was my mum. So she had to be killed. By the time he started explaining how he killed her I partly lost consciousness. I prayed to God to give me His spirit to revive me and give me more strength to continue, as I felt it was His mission I was on. Miraculously I felt warmth from my head to my feet, I felt like a big rock melting from my chest and my head. I felt very refreshed, cleaned up my tears and carried on the conversation tremendously relieved from my whole being. I then told him that I have personally been forgiven all my wrong from God and that it is in the same spirit that I was coming to him offering him pardon myself. Then it was like a huge veil off his face he started smiling with a lot of words of gratitude. He started holding my hands and telling me many other things I couldn’t expect about himself and the reality around the genocide. He agreed to go and see other people for whose family members he killed.”

Fourteen years later, Rwandans are still struggling to reconcile the past. The struggle, however, is proving easier against a backdrop of national stability, economic growth, and a rising national profile. Foreign investment is at a high, there are swank hotels, and tourists are coming by the thousands.

Post-genocide history is mired in enduring civil conflict and instability. Rwandans know firsthand that exports such as peace and stability are far superior to tales of disaster, massacres, and corruption. Rather than provide the object lesson of what can go wrong, Rwanda now embodies quite a different ideal. The nation was one of the first to send peacekeepers to Darfur and today has one of the largest contingents on the ground. Nothing points more clearly to Rwanda’s recovery and resolve.

Tortillas

Tortillas are a staple part of my diet when I'm in the States. Here in Rwanda, though, they're pretty much impossible to find, so this week I decided to take a stab at making them myself. The end result could probably pass as pita or chapati or any other flat bread, but they're close enough to tortillas to make me happy!

Vaccine search is vital

In response to the article from the AIDS Healthcare Foundation (see 'Enough is enough'), several leaders in the HIV/AIDS research community, including Dr. Eric Hunger, who works closely with Projet San Francisco and our field sites in Zambia, published another article in the Atlanta Journal-Constitution.

Vaccine search is vital in HIV/AIDS arsenal
by: Mark Mulligan, James Curran, Eric Hunter, Carlos del Rio

In an April 7 opinion column, Drs. Homayoon Khanlou and Michael Weinstein of the AIDS Healthcare Foundation made several statements with which we strongly disagree ("The best way to fight AIDS," @issue).

Global access to HIV/AIDS prevention, testing and antiretroviral treatment is inadequate, and increased funding is needed. We strongly disagree, however, with the suggestion by Khanlou and Weinstein that the best way to fight AIDS is to end government funding for HIV vaccine research and to redirect those funds to prevention, testing and treatment.

History teaches that it is wrong to take an either/or approach to the provision of health care services and vaccine research. In the U.S., despite sustained prevention efforts and widespread use of antiretroviral treatment, 40,000 people are infected with HIV each year. Globally, more than 33 million are infected with HIV. UNAIDS estimates that in 2007, 2.5 million people became infected and 2.1 million deaths occurred from AIDS. Each day, 6,800 persons become infected and 5,700 die from AIDS.

Despite impressive initial steps in antiretroviral rollout in developing countries - due to the U.S. President's Emergency Plan for AIDS Relief and other programs - only a fraction of those in need of treatment have received it. The number of HIV-infected persons being treated with antiretroviral drugs in less developed countries is fewer than either the number of deaths or new infections in a single year. Since therapy does not cure HIV, every new infection represents a person who ultimately must be treated for life.

More attention to HIV prevention is urgently needed, and quality education, counseling and testing and other services are warranted. Even when these are fully utilized, it is likely that the number of new infections will remain high.

New and better HIV prevention interventions are clearly required. Historically, vaccines have been the most effective weapons against infectious diseases. The world desperately needs a vaccine for HIV prevention. Khanlou and Weinstein incorrectly stated that there is no precedent for a vaccine against the retroviruses, the viral family to which HIV belongs. Veterinarians administer a vaccine for protection against the leading viral killer of cats, a retrovirus called feline leukemia virus.

Research is a time-consuming process of trial and error, hypothesis generation and testing, refinement and retesting. Vaccine development historically has taken decades, with each interim result contributing new knowledge. The recent clinical trial called the Step Study tested one candidate HIV vaccine. It was disappointing that the vaccine did not protect those who received it. But the study was successful in that it was well-executed and efficiently provided an answer, albeit not the desired one.

History provides powerful lessons. The virus that causes polio was discovered in the 1930s. Initial vaccines tested in the 1930s were ineffective. In the 1940s and early 1950s, summertime polio epidemics caused fear and panic in industrialized countries. Fortunately, vaccine research continued despite initial failures. Progress was based on incremental scientific advances such as the discovery in 1949 by John Enders and his colleagues of how to grow the polio virus in the laboratory. Six years later Jonas Salk's inactivated, injected polio vaccine became available.

By 1957, the number of new polio cases annually had fallen by 90 percent, and over time - thanks to sustained scientific effort even in the face of early failures - the iron lung became a museum relic. Imagine if the polio vaccine developers had given up after 20 years, or after a couple of failed vaccine trials.

The National Institutes of Health Summit on HIV Vaccine Research and Development was held in Washington on March 25, led by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. At this meeting of vaccine and AIDS scientists, care providers and community members, Fauci unequivocally expressed the government's commitment to sustained HIV vaccine research. Based on the input of the summit participants, NIAID will review the balance of resources devoted to HIV/AIDS research and make adjustments to match the state of the science.

Funding for HIV vaccine research must not be cut. If anything, it needs to be increased. Persistence, sustained scientific effort and increased collaboration will drive the quest for an HIV vaccine forward - just as they did for the polio vaccine.

Mark Mulligan is executive director of the Hope Clinic of the Emory Vaccine Center. James Curran is dean of the Rollins School of Public Health and co-director of the Center for AIDS Research at Emory University. Eric Hunter is a professor of pathology and laboratory medicine at Emory and co-director of Emory's Center for AIDS Research. Carlos del Rio is a professor of medicine at Emory and co-director of the university's Center for AIDS Research.