I spent four most excellent days in Burundi this past week visiting other Global Health Corps fellows' placement sites and enjoying taking in a new country. It was fun to practice French a bit too!
I arrived Thursday morning, and spent Thursday night and most of the day Friday at Village Health Works in Kigutu, Burundi. VHW operates under a similar model to Partners in Health (providing free, high-quality healthcare to rural communities while engaging with other social determinants of health) and its founder was the topic of Tracy Kidder's haunting book Strength in What Remains. It was fascinating to visit the site and see their successes and challenges.
VHW has a Pima machine that was purchased by CHAI two years ago for a pilot run before CHAI left Burundi. However, due to government bureaucracy and challenges with suppliers they haven't been able to procure reagents for it for a full year even though they have money to do so, so the machine has been sitting idle and patients have not been able to receive CD4 results and begin antiretroviral therapy. I wished I could have smuggled some Pima supplies out of Uganda! From what I could tell, they provide excellent antenatal care and PMTCT services, yet they still don't have the ability to perform cesarean sections, so they have to refer patients needing them to a nearby hospital that is frankly awful.
Being there reminded me of the difficulty with focusing purely on health delivery. One of VHW's big activities is educating people in their catchment area about nutrition. Cassava, a nutrient-poor food containing cyanide, is the staple food in their region; its consumption exacerbates malnutrition. One of the doctors at VHW told me that in the less-fertile areas of Burundi where cassava doesn't grow, there is less malnutrition because people are forced to raise healthier foods! It has been a major struggle to change behavior to encourage farmers to grow foods that might not taste as good but are much healthier, and this has caused significant loss of life and productivity.
It also reminded me how interconnected health systems are. Despite being well-run and fairly well-funded, VHW often struggles to get the right supplies and to provide all the services patients need because it is still in many ways reliant on the very weak Burundian health system and health supply chain. I think VHW's work is important not only because it allows people who wouldn't otherwise be able to access quality healthcare, but also because it provides a model of service delivery and should be able to become a teaching hospital for Burundian doctors down the line. At the same time, being there reinforced my belief in the need to work with and strengthen government health systems, as these impact patients throughout the country and can affect even a relatively independent organization like VHW. Tough to do in the most corrupt country in East Africa though.
Over the weekend, I met up with fellows based in Burundi and Rwanda who were in town, and had a great time hiking in the mountains about an hour from the city, going to the beach (pretty despite bad weather - Bujumbura is right on Lake Tanganyika), and eating the best Italian food I have had in Africa.
I arrived Thursday morning, and spent Thursday night and most of the day Friday at Village Health Works in Kigutu, Burundi. VHW operates under a similar model to Partners in Health (providing free, high-quality healthcare to rural communities while engaging with other social determinants of health) and its founder was the topic of Tracy Kidder's haunting book Strength in What Remains. It was fascinating to visit the site and see their successes and challenges.
VHW has a Pima machine that was purchased by CHAI two years ago for a pilot run before CHAI left Burundi. However, due to government bureaucracy and challenges with suppliers they haven't been able to procure reagents for it for a full year even though they have money to do so, so the machine has been sitting idle and patients have not been able to receive CD4 results and begin antiretroviral therapy. I wished I could have smuggled some Pima supplies out of Uganda! From what I could tell, they provide excellent antenatal care and PMTCT services, yet they still don't have the ability to perform cesarean sections, so they have to refer patients needing them to a nearby hospital that is frankly awful.
Being there reminded me of the difficulty with focusing purely on health delivery. One of VHW's big activities is educating people in their catchment area about nutrition. Cassava, a nutrient-poor food containing cyanide, is the staple food in their region; its consumption exacerbates malnutrition. One of the doctors at VHW told me that in the less-fertile areas of Burundi where cassava doesn't grow, there is less malnutrition because people are forced to raise healthier foods! It has been a major struggle to change behavior to encourage farmers to grow foods that might not taste as good but are much healthier, and this has caused significant loss of life and productivity.
It also reminded me how interconnected health systems are. Despite being well-run and fairly well-funded, VHW often struggles to get the right supplies and to provide all the services patients need because it is still in many ways reliant on the very weak Burundian health system and health supply chain. I think VHW's work is important not only because it allows people who wouldn't otherwise be able to access quality healthcare, but also because it provides a model of service delivery and should be able to become a teaching hospital for Burundian doctors down the line. At the same time, being there reinforced my belief in the need to work with and strengthen government health systems, as these impact patients throughout the country and can affect even a relatively independent organization like VHW. Tough to do in the most corrupt country in East Africa though.
Over the weekend, I met up with fellows based in Burundi and Rwanda who were in town, and had a great time hiking in the mountains about an hour from the city, going to the beach (pretty despite bad weather - Bujumbura is right on Lake Tanganyika), and eating the best Italian food I have had in Africa.
With Claire, the current GHC fellow at Village Health Works, and Melino, the Medical Director
Part of the VHW demonstration farm
Claire working with Peter at VHW
The lab at VHW
Hiking near Ijenda
During a mini adventure when our driver, Justin, lost his keys during our hike. We had to wait more than an hour for his buddy to bring a back-up set. He decided we should go for a walk to town to kill time, and we ended up accompanied by these ladies with seriously excellent baskets.
At Bora Bora beach club with Cori and Leah, two of the fellows based in Burundi
By the market in Bujumbura with Cori and Leah
Terrible photo of a pretty great dance party at Village Health Works
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