Social Justice In Practice

Leading healing and change in communities at the margins of society
by Dr. Jean Bosco Niyonzima

"Our goal is to create a beloved community and this will require a qualitative change in our souls as well as a quantitative change in our lives." - Martin Luther King, Jr.

Suffering, awakening and commitment to social justice
A personal story

I’m a physician, originally from a rural village in Rwanda. I was twenty years old in 1994 when the genocide in my country took the lives of almost one million people in just 90 days. Being witness to this horrendous suffering and mass violence shook my Christian self and engulfed me in an existential crisis which forced me to ask myself hard questions. What is the meaning and the purpose of life and what is my place in it? Why do people have to suffer so much? Why does God allow such sufferings? 

Wrestling with these questions has been a long and painful journey, but it has also been a necessary one for my liberation. I read many books, and intellectually I could understand that suffering is like a messenger, an opportunity to learn and grow individually and collectively, yet I was still experiencing deep pain within myself. 

I read Gandhi’s book, All Men are Brothers, which helped me to understand that, more than anything else, Rwanda needed spiritual healing. With the additional help of a spiritual mentor and readings on Liberation Theology from the Catholic Christian tradition, I realized that the best way that I could contribute to the spiritual healing of Rwanda was through social justice service—dedicating myself to working preferentially for and in solidarity with poor people to help them regain their power and change the unjust social structure that was the root cause of violence and suffering. 

Having witnessed time and again the vicious cycle of poverty and disease in which the poorer you are, the sicker you become, and of course, the sicker you are, the poorer you become, bringing social justice into the world through the field of medicine made the most sense to me as a vocational calling. Unfortunately, the poorest, especially in the remotest areas, are often those most forgotten by healthcare systems, which meant I was signing up for a long road full of many kinds of individual and collective suffering.

In my fourth year of studies, I thought about quitting medicine all together. During my practicals in a pediatric malnutrition ward, I was shocked to see how doctors and nurses were only focusing on treating symptoms. No one was asking how to create opportunities for mothers to sustainably address the problem of lack of food, which was the root cause of malnutrition in all of these small children. Being confronted with these systemic limits challenged my admiration for and beliefs in classical medicine as a way of contributing to the healing of my fellow citizens, and this realization worsened my existential crisis. How, as a doctor, could I contribute to the healing of the world not only by treating diseases but also by addressing the underlying causes like poverty? What was my impact going to be? 

What is the meaning and the purpose of life and what is my place in it? Why do people have to suffer so much? Why does God allow such sufferings?

As a Christian evolved in a dualistic spirituality, I had been struggling to feel and experience God who thus far seemed very distant to me and indifferent to my suffering. Until one day, as I read the verse of John 3:30, “He must increase, but I must decrease.” I felt the presence of God within me. In his book, En relisant les Evangiles, Arnaud Desjardin used this verse to describe, in the language of the Gospel, a non-dualistic Christian spirituality. With this experience, I began a practice of Tai-Chi, and John’s verse became my daily prayer. I again felt God “increase” in me as I was reading Eckhart Tolle’s work The Power of Now

Over time, I began to feel uniquely connected with what Tolle calls “something immeasurable and indestructible” or what I might call a feeling of oneness with the whole being. My spiritual identity as a SOUL (Single Outflow of the Universal Life) became a reality that I began to live through my daily life. My personal and vocational commitment to healing through social justice became more real and rooted in my awareness of the interconnectedness of all beings, mindful that as Martin Luther King, Jr. has written, “whatever affects one directly affects all indirectly.”

Herein began the end of my suffering. I awakened to peace with everything. In communion and in love with everything, I was able to find meaning in everything. Ten years later, I can attest that the experience I had through that time in my life has remained an indelible part of my being. With this awakening, the field of medicine took on a different sense. I began to focus on the healing and development of the whole person, integrating my understanding and knowledge of the biological, psychosocial, cultural, and spiritual dimensions of life. 

Suddenly, as a doctor and a healer for those at the margins of the society, I became connected to the most transformative and rewarding work I could do in this world. I am now engaging with communities alienated by the oppressive and exploitative systems; giving hope to the hopeless; and working in solidarity with people for emancipation from all kinds of social injustices such as classism, sexism, racism, and militarism. In all that I do now, I honor that the real revolution is evolution. I know now that, as Thomas Merton believed, for any radical social, cultural, political, or human change to be real and truly effective in the long run, it has to be spiritual.

Putting values into practice
A story of courage and creative imagination

From 2011 to 2013, I served as the Medical Director to Last Mile Health (LMH), an organization working on the front lines of health care in rural Liberia. Through this post, I was able to bring the notion of spiritual healing and transformation into the field of healthcare delivery in collaboration with other pioneering leaders like Dr. Raj Panjabi, the co-founder of the LMH. 

Bridge in Konobo before LMH supported its rebuilding

Bridge in Konobo before LMH supported its rebuilding

LMH’s program in the Konobo District of Liberia is a real story of courage and creative imagination. Konobo is one of the most remote districts, located in the southeastern region, near Ivory Coast. According to the government figures, the District has 34,000 people living in 42 communities, all scattered in a dense rainforest. There is only one health center, which, before LMH arrived, was geographically accessible to only one third of its population. The roads to and within Konobo were (and many still are) treacherous with very dangerous bridges, if any. Before 2012, health indicators were amongst the worst in Liberia. 

Despite fierce opposition and discouragements from different powerful security and health stakeholders, Konobo was where Last Mile Health decided to go and begin an innovative community-based health service delivery program. Nearly everyone told us that providing health care in Konobo was unwise and not feasible. It was “too far,” “too difficult,” “too expensive,” and “too dangerous.” 

The decision to go where others didn’t dare go took extraordinary faith and courage. As a team, we committed to finding solutions together and to challenging the orthodoxy and status quo. I’m happy to say that our efforts paid off. Today, all of the District is being served by well trained, supervised, equipped, and incentivized Frontline Health Workers (FHW), who together form a network of care in support of the health center. In only one year, the health indicators improved exponentially. 

Even more inspiring to me than these indicators, however, is the feeling that LMH and all of its members share values of love, compassion, and courage. At all levels of the organization, people are bringing a kind of spiritual grit to the hardest-to-reach corners of the District. 

Markson (right) on a home visit.

Markson (right) on a home visit.

Last year, I was called by a nurse for medical support at the Konobo Health Center to help manage a four-year-old male patient—we’ll call him Patrick—who was admitted for cerebral malaria with hypovolemic shock. I arrived to find my colleague, Markson (an FHW from a distant village) at the bedside with Patrick’s parents. Markson had identified danger signs in the child—seizures and impairment of consciousness—and made the diagnosis in Patrick’s home. Markson immediately referred and accompanied Patrick and his parents to the health center 30 kilometers away. 

One year earlier, before the FHWs were trained to diagnose and treat malaria, pneumonia, diarrhea, and malnutrition in infants and children under 5 years, most of children living in the distant villages with such conditions would have died with no access to dignified healthcare services. Today, this is no longer the case. 

Patrick’s parents gave birth to six children, three of whom died from infectious conditions before they reached two years of age. And the same fate would have awaited Patrick had it not been for Markson’s service. To reach the health center as fast as possible, they used motorbikes, crossing the bridges, which had been repaired by the community through the financial support of LMH. Without those bridges, which were impassible a year earlier, what good would our FHW network be? Needless to say, LMH had comprehensively considered each level and challenge to the healthcare delivery system so that Patrick could get the care he needed. Without LMH, and specifically without Markson, Patrick would have died like so many others whose parents previously considered it impossible to get health care in the rainforest. 

My service in rural Liberia as a foreigner—and as the first doctor in the history of such a remote district—helped change the many skeptical minds who had told us it was “too far,” “too expensive,” and “too dangerous.” As a friend working with an international non-governmental organization told me when he visited the place, “This is really the most difficult place I have ever seen, you are a real humanitarian.” But, whether they call me “humanitarian,” “bush doctor,” or “bush cowboy,” it isn’t just about me. As God “increases” within me, I feel more responsible to contribute to the emancipation of those who are marginalized through a service of love and solidarity. LMH provides opportunities to work in solidarity for a real social transformation not only to me but also to the people of the District who had been forgotten for so long. 

Markson himself touts the LMH spirit of love, courage, and service—a spirit that helped unlock his potential for healing through service and a spirit that he inherited much as I did during my own personal transformation back in Rwanda. I never once saw Markson surrender in the face of difficulties. His selflessness, courage, and dedication to his community inspires trust and credibility among his neighbors. His accompaniment of Patrick reflects the love he has for his patients. His fruitful collaboration with the medical staff at the clinic shows his confidence and commitment to helping save lives, whatever it takes. 

It doesn’t just happen
The role of transformational leadership 

I had the privilege to serve the LMH program in Konobo as a leader, and over my time there, I experienced how leadership is an opportunity to empower people and to inspire them to unlock their (sometimes hidden) potential. I learned that this had to be done by example—I was called to share who I am and how I am committed to serving with humility, love, compassion, dignity, selflessness, and courage. I believe that a healed and transformed leader inspires others through the values he or she lives, which then spread contagiously to others. Working collaboratively with other exemplary leaders deepened my commitment to trying to live my spiritual values through every interaction. This, I believe, is what created that culture of collective courage, love, compassion, and creative imagination that has made LMH what it is today. 

I know that Raj, Markson, and I all went through different paths of healing and transformation, but through our own processes, we each recognized that we share an interconnected vision of life and humanity. The three of us, and so many others working with LMH, believe that by living this vision, serving others can be, in and of itself, continuously healing and transformative. It’s like a boomerang effect. The healing is ongoing and collective. The transformation is ongoing and collective. This ethos penetrates all levels of LMH’s committed staff, like Markson who is committed to traveling alongside the destitute sick for 30 kilometers or more to ensure they get the care they need or like the driver who said jokingly when our car was stuck in the mud, “no retreat, no surrender.” 

Through this service and these relationships, I commit to staying tethered to how I’m both healer and in need of healing so that my ongoing transformation can unfold.

Through this service and these relationships, I commit to staying tethered to how I’m both healer and in need of healing so that my ongoing transformation can unfold. It’s amazing to see the words of Martin Luther King, Jr. lived out through our collective efforts. He said, and I feel, “We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly.”

Organizations and communities living a culture of collective courage, love, compassion, and creative imagination are quite unique, and they don’t just happen. As leaders of LMH, we took responsibility and ownership of our own healing and transformation first and foremost. Only with deep awareness of ourselves could our work inspire and instill a vision and a set of values in the organization. I wish I could share all of the stories of healing and transformation from Konobo.

This work of real social justice is not easy. For such efforts to bear fruits, they must be underpinned by a spiritual maturity, which is also not easy. I believe such efforts require courage, compassion, love, fearlessness, and faith in life. In order to evolve to a level of experiential and lived understanding of such values, it is incumbent upon each of us as individuals to go through a personal transformation in relationship to suffering. Some may find the meaning of their suffering through a biblical verse or inspiring book like in my case, others may need to meet inspirational people who believe in them as in Markson’s case, and some may need entirely different experiences. 

We may all take different paths with our healing. And yet, one of the primary reasons we ought to be concerned with our own relationship with suffering in these efforts is because the temptation to succumb to discouragement, fears, possessions, power, honors, and more in the face of life’s pain is high. Gandhi said, “They first ignore you, then they laugh at you, then they fight you, then you win.” So, what happens when we win? It is profoundly important to be aware of the temptations and negative forces within and around us, so that we remain open to changing ourselves as we serve others. 

Working with LMH gave me the opportunity to introduce the notion of quality improvement in the hospital in rural Liberia. Most of the health professionals I met there were initially very reluctant to do what offering quality care would require of them. Despite my frustration, I decided to work in a way that is aligned to my values. After one year, one doctor colleague of mine told me very candidly, “We are very proud of you and grateful that you changed the perception of what quality care is in our hospital. We first thought you were crazy when you were rounding five hours while others could not go beyond one hour. But the fact that you consistently kept the grit, many of us felt challenged, which pushed us in changing our practices.” I had been tempted to give in, to give up, to stop trying so hard, but my vocational calling wouldn’t let me. Ten years since awakening to the healing that I needed in my life, I can say that deep within me, I know what it means to be the change I want to see in the world, as Gandhi said. But, again, this social justice service put into practice isn’t about me. It is, rather, about cultivating the presence of God within me and seeing it in others. §

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Jean Bosco Niyonzima is a Rwandan physician, currently working as the founding director of clinical programs for PIVOT, a non-profit service organization in rural Madagascar. Prior to working with PIVOT, Jean Bosco served as the Medical Director of Last Mile Health/Tiyatien Health in Liberia. Jean Bosco has previously worked with Partners In Health and completed his Masters in Sustainable Development at SIT Graduate Institute. He is committed to social justice and human emancipation in our world of contradictions.