Strength in What Remains | By Tracy Kidder | Random House | 304 pages, $26

“The world is full of miserable places,” Tracy Kidder wrote in Mountains Beyond Mountains, his 2003 chronicle of Paul Farmer, a Boston doctor who worked to bring adequate health care to ill and desperately poor people in Haiti. “One way of living comfortably is not to think about them or, when you do, to send money.”

Like Mountains Beyond Mountains, Kidder’s new book, Strength in What Remains, is set in some of the world’s miserable places. Unlike Paul Farmer, however, the main character didn’t choose to be there. His name is Deogratias, and he is from Burundi, the East Central African nation that in recent decades has been as plagued by genocide and ethnic strife as its neighbor to the north, Rwanda, though its struggles loom perhaps less obtrusively in the consciousness and conscience of the West.

Raised on a mountain settlement of farms and pastures where cows are a form of currency, Deo enjoys a peaceful childhood among his parents, many siblings and extended family. Still, the agrarian existence means a life of labor for young Deo, set in a poverty-stricken landscape where children go hungry and the lack of a public health system results in widespread suffering from parasitic and infectious disease. In the face of these misfortunes, Deo’s people rely upon Christianity—imported by Belgian colonialists, who ran the country from 1918 until the 1960s—and bits of folk wisdom supplied by village elders: “When too much is too much or too bad is too bad, we laugh as if it was too good.”

Deo distinguishes himself as a student. His school, which is run by the Catholic church and where students are routinely beaten, is located far from his family’s home. Each day he makes the long trek “along paths that cut through pastures and banana groves and gardens of beans, and quickly through a dense wood where, he’d heard people say, bad spirits lurked, then down again to a stream bottom, a small piece of open flat land, where sometimes he and his classmates would meet up with kids from the Protestant school in Nanga and play soccer, or fight, or both.” As his classmates drop out or die from illness, Deo continues to excel at each level of his schooling. Eventually he enrolls in Burundi’s medical school, hoping to someday build health clinics to aid the poor.

In 1993, while Deo is still in medical school and working as an intern in a local hospital, the Burundian president is assassinated, setting off a violent panic and an explosion of simmering Hutu-Tutsi resentments. Deo, a Tutsi who has all his life only vaguely understood the country’s ethnic divisions and puzzled over the reasons behind them, is suddenly a marked man: the Hutu majority is killing every Tutsi it can find, waging low-tech total war with spears and machetes.

What follows is an account of Deo’s escape—an insufficient word, perhaps, to describe a predicament in which it is not clear what he is fleeing to or from. He runs and hides for six months. “It was impossible to plan, because he never knew where the dangers lay until he got close to them. The signs were obvious by now. Rising smoke meant burning houses up ahead, and wheeling birds a place full of corpses. Swarms of flies meant killings nearby. Sometimes he saw a dog trotting past with a severed head or an arm in its mouth. The main thing to avoid was other living human beings.”

Deo’s flight takes him across the border into Rwanda and a succession of refugee camps, where he hopes to pass as a Hutu. Eventually he manages, through the help of a medical school friend, to board a plane to America. He assumes his entire family has been killed.

Gregory Beyer is a journalist whose work has appeared in The New York Times and the Los Angeles Times.