By Jennifer Weiss, Health Advisor, Concern Worldwide US
I started my work in Burundi around a year ago. Before I visited the country, I remember my colleague describing Burundi to me. “It’s off the grid,” she said.
The comment struck me as odd. I assured her that I had lived in Africa before and was more than prepared for the work that lay ahead. I couldn’t possibly understand what she meant by “off the grid.”
I quickly learned. Burundi, despite its geographic proximity to Tanzania, Kenya, and Rwanda, countries with growing economies and booming tourism industries, is heartbreakingly poor. In fact, Burundi is one of the world’s five poorest countries. I knew this statistic before departure. However, it wasn’t until I arrived in Burundi’s capital city of Bujumbura that I completely understood my colleague’s description. While in other capitals there are new businesses and construction, in Bujumbura there are none to be seen. When I asked a friend of mine who had been in Burundi in the ‘80s to explain how the capital had changed since then, she frankly responded: “It hasn’t.”
Yet, despite the unaltered state of the urban landscape, I see great hope and change in Burundi. Perhaps too often overlooked is Burundi’s stunning beauty: the lush mountains, the blanketing greenery, the villages or colline perched atop the peaks of countless hills. These villages are commonly reached by winding footpaths, sometimes a two or three-hour walk from the main road. The people living in these communities are accustomed to the climb. Gathering water, a chore for children anywhere from three years old to teenagers, can involve a walk (or hike) of around an hour.
Because the journeys are long and arduous, most villagers do not immediately seek medical assistance at the first sign of illness. It is the children who are the most vulnerable. Malaria, diarrhea, pneumonia, and malnutrition are the most prevalent health concerns within these communities, predominantly affecting children ages five and under. Although treatable, these diseases become fatal when not detected immediately.
The health centers are usually located far away from these villages, which mean that community members are often deterred from making the journey. There is also a basic lack of understanding about common diseases. It is part of our goal to aid in the training and educating of communities on healthy practices at home.
Concern’s work in Burundi is unique in that we work to strengthen existing government-implemented health programs. For me, this is really important. We want to help government set up an infrastructure and empower the communities, not do the work for them.
Concern is currently working with the government to roll out what we call “community case management” in Cibitoke province. This approach is exactly what it says it is: manage cases of common illnesses in communities, rather than at a central point, like a health facility. This decentralized health care system is hugely practical for isolated villages that are not near a health facility—which is true of most of the colline that I visited.
But community case management cannot happen if communities do not have the knowledge they need to prevent, diagnose, and treat common illnesses. This is why so much of what we do focuses on training of local community members.
When trying to get people to adopt healthy practices, members of the community are much more likely to listen to their peer, than an outsider. If I just walked in there and told everyone that they had to treat their water before drinking it, they wouldn’t listen to me. “Why boil our water?” they would ask. They’ve never boiled or added chlorine to their water before; why start now? I don’t have much credibility. I’m not from there. They’re much more likely to pay attention if a friend or member of the community is offering the advice.
And it works! We have more than 3,000 women’s group volunteers in the Mabayi district. We are working on a huge scale to spread health messages. It is simply incredible the number of people we have reached: 56,998 women of reproductive age and 44,112 children under the age of five.
While knowledge is power in preventing illnesses, people—particularly children under five years old—will get inevitably get sick, and community case management would not work if there isn’t anyone available who can diagnose and treat common illnesses. This is where community health workers come in, who are trained to not only teach their peers about healthy practices, but also to provide frontline health care services.
We have trained more than 150 community health workers in Cibitoke province, one of whom is Nduwayo Protais. He was one of the first community health workers who we trained in 1999 by our very own Health Program Manager, Delphin Sula. He can now treat children under five who have diarrhea and can perform a simple finger prick test to see if the child has malaria. This means that mothers do not have to travel long distances to the nearest health center to help their children. They do not have to leave their other young children, farms, or household work. They simply have to visit Nduwayo, and for this, he has gained recognition in his community as a leader.
Delphin Sula, the Child Survival Project Manager in Burundi, put it best: “I remember when this was just an idea and everyone was saying, ‘don’t mention it! It can never be done!’”
But it is being done, thanks to the optimism and persistence of these community leaders.
It isn’t easy for me to describe Burundi. I can comment on the poverty or stagnant economic growth, but I prefer to communicate its beauty and resilient people. Even on the most perilous of roads or footpaths in the most remote corners of the country you will be greeted by an amahoro or “peace be with you.”
That, to me, is worth going “off the grid” for.