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Blood:Water Book Club: “A Thousand Hills to Heaven,” Section 2



In chapters 14-29 of “A Thousand Hills to Heaven,” Josh Ruxin continues his narrative of his journey alongside his wife, Alissa, to spearhead the Health Builders operation in rural communities in Rwanda. Weaved throughout this section are many personal stories of people from the Mayange community, members of Ruxin’s team, or associates who had a role in the genocide, whether as a participant or survivor. These stories range from tales of entertaining cultural idiosyncrasies to brutal accounts of survival and remarkable forgiveness.

It is also in this section that we learn more about Alissa finding her own way in Rwanda after the tragic loss of her first pregnancy. She finds her joy again while planning the opening of a gourmet restaurant in Kigali that will help employ and empower survivors.

Ruxin also focuses on his team’s extensive work to put management and organization systems into practice at overrun or poorly managed health clinics. He introduces the reader to the five rules necessary for NGOs to create sustainable development. The way in which his team and the communities follow through on these guidelines is a lesson for all in the importance of helping others help themselves. “A Thousand Hills to Heaven” makes clear that Rwanda is a country full of capable people who have paved the road to their own recovery.


Sustainable recovery; Empowerment; Faith; Forgiveness

Powerful Lines

  • “You can’t ask starving people to save themselves. You feed them. They get their strength and their wits back. Hungry people, dying people, can’t do the creative things they need to do in order to move forward. They can’t act as a community.” (103)
  • “My daily challenge, then, was to convince donors that building out management systems would save mothers’ and children’s lives now, and for years to come. Unfortunately, most were more interested in sexier stopgap Band-Aids–drugs, high-protein emergency foods, and other tangibles, rather than durable management solutions.” (120)
  • “The most important reason to demand high performance standards in development work is that you should be able to leave someday.” (124)
  • “We are not here as a lifelong commitment. We should not be married to our programs. We should ultimately never be the essential party, even though we do have leadership responsibilities at the beginning.” (174)
  • “You sometimes have to marvel at each [Rwandan’s] determination to have a life, to find happiness, and to get past the impossible, no matter whom they must forgive or what they must forgive, in others or in themselves.” (198)

Questions to Ponder

  1. How does Blood:Water’s culture align with Ruxin’s five rules for work on the ground in Africa?
  2. Which personal story affected you the most while reading? Why?
  3. Why do you think Alissa chose to return to Rwanda with her husband after the tragic loss of her first pregnancy?
  4. What do you think is the difference between aid and development? After reading chapters 14-29, when is aid necessary and when should one move toward development?

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