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Blood:Water Book Club: “A Thousand Hills to Heaven,” Section 3




In the final portion of “A Thousand Hills to Heaven,” Josh Ruxin reflects on the lessons he and his wife, Alissa, learned through opening and operating Heaven, and applies those lessons to his broader development work with Health Builders.

Throughout these lessons, Ruxin emphasizes the importance of understanding the culture in which development work happens and ensuring that those who will be impacted by the work feel a sense of ownership in it. He saw firsthand that nothing Health Builders or any other external organization did would be sustainable otherwise.

Despite the challenges of its past and the sometimes-harsh conditions found in Rwanda, Ruxin, like so many other expats who flock there, feels an overwhelming sense of hope about the future. The determination and resilience of the people, and their desire to seize the opportunities afforded them, has allowed Rwanda to quickly catch up and leave other countries behind from a development standpoint. Its focus on survival and forgiveness, and the health and prosperity of its people, not only makes them “the models of Africa,” but also lends a view to the end of poverty, and how it might be reached.


Earned trust; Transformative power of opportunity; Sustainable development; Hope

Powerful Lines

  • Rule Five is a reminder to never be afraid of the profit model, as it can carry the heaviest load of long-term development. Profit brings sustainability, not to mention dignity. (202)
  • People need opportunities, no matter how strong they are. (229)
  • I had been giving Donald short shrift. He was the better expert, and I needed to see him as that…“So what do you think we should do?” I asked Donald. Those were the best words I have ever spoken in Africa. They are the words Africa needs to hear from us more often. (241, 243)
  • You can’t have a sustainable program unless local people are running it and caring deeply about it. (246)
  • It was not as precisely managed as we might have liked, but it was their project, and that was far more important than perfection. It will go on and on, long after we’ve gone. (248)
  • There is no Health Builders’ plaque on the wall, of course – it’s a Rwandan health center, and the Rwandans will care for it and ensure that it thrives. (288)

Questions to Ponder

  1. When much of Heaven’s staff was hired, they could not pay for their most basic needs. However, after just a short time, they were able to pay for health care, food, and rent and education for themselves and their families, and almost all began working toward educations almost immediately. What does this tell you about opportunity? How do you think Rwanda’s past influences the desire and motivation to seize opportunity?
  2. Why do you think American aid organizations are sometimes hesitant to ask locals how they would address issues in their own communities?
  3. Ruxin says in Rwanda there is a very good evening view of the end of poverty. In what ways did you see this in the book?

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