Fifteen hours in the shop today
Puttin’ in time honey, making my pay
When I get home, baby, and my bones are tired
I just want to sip my drink by the fire
Cold steel showers at the Thompson Mill
It’s long hard hours makin’ that Thompson Steel
If I had my way I might be next you
But there’s certain things a man’s gotta do
Baby, what you got to understand,
I’m nothing if I ain’t a Working Man
“Working Man” - The Dip
Every day at around 7:30am, depending on the presence and intensity of the rain, and the temperament of the daily Rwandan mood regarding the concept of punctuality, I walk, headlong and knowingly, into a funeral. I enter quietly, reducing the thudding of my heavy feet down to a soft patter. Though eyes fall on me with my non-conspicuous entry, tall and clearly non-Rwandan as I am, no one speaks as I enter. I sit wordlessly for a time at the table with roughly half of my health center staff in attendance. The mood is typically morose. They stare mostly at the ground, but occasionally their eyes will defy the angles of their downward heads, looking up at me with forlorn and tired glances. With their hands on their mouths and hoods flipped over their heads like turtles trying to retreat into their shells, they eventually acknowledge my presence in soft, muffled tones.
“Mwaramutse…” one says, from across the room. With the glacier of ice cracked slightly, others gain their confidence and the hushed Kinyarwandan greeting begins to slowly cascade across the room towards me. When the lukewarm greeting finally makes it way around and lands on me in a mushy, damp heap, I feel obliged to shake off its odd feeling. “Good morning!” English tumbles out of my mouth and my booming voice betrays the somber mood. The sound of my own voice startles me and I stiffen with embarrassment, trying to gather the loud words back into my mouth from where they so rudely bursted from. A correction. “Sorry,” as I dial the volume of my own voice down to a somber tone that matches the mood. “Mwaramuste neza…”. Slow nods and assenting murmurs meet my more culturally appropriate greeting. I hang my head in solidarity. We continue on in the heavy blanket of silence.
Wait did I say funeral? I apologize, that must have been a Freudian slip. What I meant to say is that every morning I leave my house, walk down the road and walk into my Health Center staff morning meeting. As a thoroughbred American, my entrance into our daily staff morning meeting initiates what occurs to me as a massive culture clash. But since the cultural distinction is only noticed by me, rather than this crashing taking place as a noisy head on collision, it is more like a silent smashing of satellites in the vacuum of space which is my mind.
I have been attending our staff meetings more or less consistently since I arrived in my town in Mid August. They are, every day without exception, the antithesis of what an American meeting would look like. I find their mood and cadence so deeply odd that despite my regular exposure and extensive cultural integration, I have to this day only become slightly habituated to them.
The director of our health center, a middle aged Nun who strikes a cold fear into all her employees, sits not at the head of the rectangular meeting table but just off to the side of it. Instead of making clear the purposes of each meeting and decisively taking control of the room, we often sit for a confused silence before she decides, without any regular recognizable provocation, to invite someone to kick off the meeting with a prayer. Before I was able to pick up on the imperceptible cues, I was often caught with my head up and eyes wide as my colleagues plunged into sober bible verse.
After the prayer, from what I can gather, the employees in attendance go around announcing what they will be doing for day - but in a display of deference gone awry, they speak in hushed tones that are almost indecipherable, looking at their feet or at the stitching of the elbows of their sweatshirts. They speak so softly that my neck imperceptibly cranes towards them and my eyes squint with consternation as I try to distinguish even a single word they are saying. The director, having summarily banned phone usage by all employees during the morning meeting, receives these barely audible missives by staring blankly into the inviting glow of her own Samsung Galaxy.
In between each employee speaking, there is an indeterminate silence, until others decide to have their turn at irregular intervals. The meeting continues on until, for lack of a better phrase, it just sort of ends. With no indication of body language to signal the conclusion, the director will say “nice day” in Kinyarwanda - at which point all staff members slowly get up one by one and walk out, seemingly burdened, to the point of carrying physical weight on their heads, with their shyness and submissiveness in her presence.
At first I would sit on, bewildered, trying to make sense of why our meetings were conducted this way. But by now, on a normal day I get up and leave alongside my colleagues, albeit I move with a little quicker pep in my step. When the meeting ends I have to make good use of the time - I don’t know how much time I will have alone, and the clock is ticking until… They Come.
I would say that during this period I have roughly an hour to myself, so I adjust my reading materials and writing schedule accordingly. My health center, being so close to town and having the resources to support a large staff, is lucky to have a reliable and fairly strong wifi modem. And like a moth drawn to a light by the biomechanical phenomena of taxis, I gravitate towards it as if I have no agency.
I know They Are Coming. With a desperate enjoyment I check the news and read about the happenings in America - careful to consume only the hard news that will confer some useful knowledge and not the opinion pieces that I mired myself in during my days in DC. As I read, my eyes flick to the computer clock. How much time do I have? With the latest in Can-You-Believe-What-Trump-Said, I usually migrate to lighter and dryer international news and then mercifully into baseball news. But in the offseason, there is hardly enough material to whet my palate. Trade deals and arbitration contracts aren’t enough to keep my mind off of the future. The cloud hangs ever presently over my head. They Are Coming, They Are Coming.
Mama Says
A knock at the window snaps me into reality. It’s always my Counterpart Cecile, and she always says the exact same thing. “Alexi,” she pauses for effect. “Ababjyeyi bajye”. I know what it means. The mothers are here. It’s time for Milk Morning. I tear myself from the warm embrace of my laptop and come to terms with my sentence like a man convicted at the Defendant’s bench. All I want to do is read, but I’m at work now and there are things to do. I look at the clock and it’s 9am sharp. Three hours on the inside await me. Hard time for an innocent man. Will I be the same when I get out? Will I even recognize myself? I move out of the door and onto the dusty sidewalk towards meeting hall. The Red Mile.
The meeting hall, or the “Grand Room” as Cecile calls it, is a stand alone building that sits the closest, and parallel to the main road of all of the Health Center buildings. The simple piece of architecture houses one large 25’ by 12’ rectangular room that features a walk-in store room at the back, which serves as the stock area for the various food products we give to malnourished families - milk, fortified porridge, fortified peanut butter and vitamin powder. Within the main room are a series of unbolted benches that we move around depending on the anticipated number of mothers and children coming to utilize the program. Today we have brought all bench resources to bear, crammed in as closely as they will go, while keeping a free aisle in the middle. The poorest neighborhoods with the largest amount of milk distribution need are coming in today - roughly 80 registered children, all needing between 3 and 6 liters of milk for the week.
When Cecile and I set up the three measurement stations, a hanging scale for weight, a sliding Unicef board for height, and a chair with a Middle Upper Arm Circumference (MUAC) strip, she makes the call. With both of us sitting at the head of the room, she gets up to walk toward the threshold to indicate to them that it’s time. This is my last moment of peace. I usually take a few deep breaths and ask higher powers for their help, starting with the Rwandan word for God, and regressing all the way back to my childhood days in my Grandma’s church. O, help me Imana! Lord, if you’re out there, help my wretched soul and keep these kids calm. You know I hate noise more than anything in this world. Help meh Holy Spirit, help meh Lawdy Jesus-ah! But its too late. It’s always too late. They Come.
The chorus begins instantly. It had begun when they were all outside, but the improved acoustics of the room sharpens its piercing quality into a shuddering point. Crying. Shrieking. Shouting. It washes over me like a scalding bath. Another deep breath - with a quick count of the discontented children it seems that my mathematical law of Milk Day has held true.
You see, over the 4.5 months I have been doing Milk Day, which is held two, and sometimes three, times a week - I have developed a theorem, a mathematical proof, if you will. Alexi’s Law is simple way to establish what I have observed to be an unassailable Law of Nature - that, given an above threshold gathering of children on any given Milk Day, at least 10% of them will be having what is scientifically referred to as A Face-Down Snot-Nosed Shrieking Absolute Meltdown at any given time. The formula will not identify which children will be having said meltdown, as indeed it is not a personality test, it will simply verify what you will undoubtedly observe. 30 kids for Milk Day? Three Meltdowns. 50 kids coming in to assuage their mild to severe malnutrition? Five total tantrums. 82 kids from the poorest area coming in to my health center? At least eight kids losing their heads, with two newborns having a hard time to cover the remaining two tenths.
Next!
But I digress. Our job is objectively important, and measurements are not taken arbitrarily. In the campaign to end malnutrition across the country of Rwanda, the measurements are all important. Numbers for weight and height are used for each child to calculate a series of indicative scores, called “Z-Scores” that are indices for malnutrition which have been developed by the World Health Organization. In reference to their graph of normal child development, by taking the two measurements together it is possible to see whether a child falls under the standard deviations for normal child development. All the children in the milk program have, on some indication, been deemed far enough under the standard curve as to require an intervention - hence the milk provided by the government via the health center. The hope is that, as we continue to take the measurements and give milk, we will see the kids improve to the point where they graduate to our list of kids who no longer need the service. “Abana Bakize” is the name of our list - “The children who are cured” is what it roughly translates to. Considering the circumstances, I find “cured” to be a strong word, but of course the language barrier is bigger than I am.
With the theory established, we come to the practice. The problem with all of this is that kids hate it. They despise it. Every time I hold their tiny writhing arms, and dodge their twisted, leaking faces, I just wish that I could talk to them. If only their frontal cortexes were developed. If only I could explain to them that this is all in their best interest - that, if they remain calm, this can all be conducted quickly and in a civil manner. Perhaps, with a tentative reach across the aisle, Measurer and Measuree can one day be friends. Our people can live, if not happily then with a begrudging acceptance, together in a world free of malnutrition.
But, alas, they are too young. Too young to understand the theory of what is going on, and too young to cordially cooperate in the interest of themselves or their other compatriots. In the moment they only know one thing, that they hate me, hate everything I’m trying to do, and wish me ill in all my future endeavors. For upon their tiny bodies I have transgressed mightily. I have committed a cardinal sin for which there can be no recompense. I have wrapped a small, bending piece of plastic around their little arms for 3 seconds. Then I wrote the number on a piece of paper and handed it to their mothers. A biblical betrayal.
To them the Grand Room is nothing but a cruel and unusual House of Horrors, with each station boasting its own particular savagery. Below the weighing scale they dangle helplessly over the void, a staggering two feet off the ground, in a comfortable blue harness. The Unicef height board requires them to stand straight and still, which they would otherwise do at their mother’s knees, for an eternity of 8 seconds as the top of the sliding board - which to them is the cold, unforgiving scythe of the grim reaper himself - is lowered gently onto the top of their heads. And as for the disturbingly tricolored MUAC strip - well I need not recount the extent of its bendy-plastic deviousness.
For the hours that it takes to go through Milk Day, they respond to their perceived tormentor in kind. Shrieking, snotting, spitting children look at me with disdain and fear as they recoil violently from my MUAC strip, writhe in the harness so that I can’t discern their accurate weight, and seize fretfully when laid down on the height board. In the beginning, my patience and compassion outweighed my annoyance. I would try to console and cajole the children, softening my eyes and curling up my nose in what I hope will translate to their brains as clearly non-threatening physical cues. But it doesn't work; nothing works.
I’ve seen a mother breastfeed her baby in an attempt to divert his attention from the upcoming weight dangle - only to have him realize his fate midway through the process of the drop. He clutched wildly with his hands at her shirt as it was torn away - and his final point of contact, his final lifeline to the anchored world he believed he would never know again, was the very breast that gave him life. As he faded away from her, only the breast in his mouth remained, slowly stretching horizontally as the harness swayed backwards and distance increased between them. Eventually his mouth lost its strength and the breast returned from whence it came. He let go, and began to cry. Everyone laughed, I along with the rest of them.
“Umudugudu?”
Slow though it always goes, the measurement phase eventually comes to an end. What follows is the registration phase, where Cecile and I, one by one, receive each mother and write their information and update their child’s measurements. This information is housed in one of several “registers”, blue back-to-school notebooks that are ubiquitous not only in my health center, but in almost every health center I am aware of across the country. The blue notebooks, labeled on their fronts with the thin writing of common BIC pens, are the single source of the all important milk information, child measurements and milk distribution amounts within the entire health center. The information storage that any American would automatically assume is handled on computers is done entirely by hand, and stored around the health center according to no particular system. If a book was lost, destroyed, or even had a cup of water spilled on it, over a year of work would instantly be lost with no backup of any kind to support it. Many of the pages are already yellowed, bent, and torn.
And so this state of affairs requires Cecile and I to sift through hundreds of pages of notebook paper, searching with tired eyes for children’s names that up until recently I could hardly pronounce or comprehend. A mother approaches me and sees my pleading nervous eyes: please, for the love of Imana, speak slowly and articulately so I can understand you”. “Your child’s name is…?” I ask in improper Kinyarwanda. Upon inquiry she instantly loses her composure. Looking at her navel, swaying back and forth from foot to foot, and mumbling under her breath in quintessential Rwandan deference, she says her child’s name. “mpukegezinimanasandrine…” I sigh deeply. “What? Speak very!” She responds, slightly, to my exhortation. “MpukegezinimanaSandrine.” Alright, I think to myself. The first name is a wash, I literally have no idea what she said. I definitely heard Sandrine though, so I’ll look for that. I start flipping, flipping, flipping pages in the register. 20 pages. 54 pages. All 82 pages. There are four Sandrines, all with different “last” names. I ask her to repeat. Her heads drops again. This is what registration is.
“What, Can I Do”
It is at this point in the Milk Day, after I am exhausted and grated from the crying, but before hunger for lunch begins to blot out all higher thinking, that I begin to consider how I can help reform all of this as a volunteer. I think about the processes that we go through, the assembly line of measuring, the waiting around, the understaffing, the insanity of the registers, the general entropy and inefficiency that surrounds Milk Day like a dense fog. This could all be done so much faster and so much better, I always think to myself.
In certain ways, I have already managed to help. On Milk Day I bring to bear a natural speed of task completion and obsessiveness with efficiency that has been ingrained deep into my bones by American culture. In some respects I have pushed Cecile to rearrange the administrative tasks in a way that makes them faster. But there are massive barriers to overhauling the entire service, which is what is needed. Not the least of these barriers are a language chasm, the calcification of old habits, and a culture in which people are socialized to swallow their annoyances rather than question authority or demand better of their services - which breeds administrative complacency. But as I sit and consider these things, we still have tens of mothers left to process, and we haven’t even come to the main reason for the season - the actual distribution of the milk.
In months past, each child used to receive 7 liters of milk, one for each day of the week, every time they came in on milk day. A very recent 200% increase in our milk program rolls, and what I’ve assumed are governmental supply chain issues regarding the milk, have reduced the amount we can give to half that amount - 3.5 liters per child. But even with the reduction, the milk stock room is massive, and each Milk Day requires 30-40 boxes of bagged milk for every one to get their share. As Cecile calls the mothers to sign the registers, I get to cracking the boxes and consolidating the milk into distributable 3.5 liter units.
At this point, the final stage, I’m usually haggard. It has been hours of noise and running around. All young children are naturally gross, but the village kids fill the Grand Room with a certain kind of smell that is difficult to bear after some time. I work as fast as I can to get them their milk so that we can all go home for lunch. Finally, the last mother receives her share. I always give the last mother a big smile. I’m happy to be helping, and I’m happy to be done.
Moreover, when the noise dissipates and my cortisol levels decrease, I can see that there is a clear necessity for the milk program. When interacting with the village mothers, it always occurs to me that these are among the poorest people I have, and likely ever will interact with in my life. Whether or not the policy is carried out effectively doesn’t change the reality of the situation: these women, and particularly these kids, need assistance. I remind myself that though the changes have been small, Milk Day has been slowly improving since I’ve been here. I can see some of the kids getting better and the mothers always seem to appreciate my recognition of their children over time (the ones that I like at least).
As I walk out the door, a last grasping thought occurs to me about how all of this can be made better. But at last, exhaustion wins the battle. “I’ll take it up next Milk Day”, I think to myself. I walk home to make myself lunch. Milk Day is difficult, and riddled with deep problems from top to bottom - but at the end of the day, everyone gets a good meal.