This is not the Africa in travel brochures with safaris and delicious wine. This is the Africa where heavy loads are carried on undernourished heads, babies on backs and rifles in the hands of teenage boys. Here in the torrential rain, barefoot children hide under banana leaves. The soil runs deep red as if the blood of the hundreds of thousands of people who have died here from civil war and starvation have drenched the earth of this small nation to its core.
International Medical Corps has worked in Burundi since 1995, providing essential services, many of which aim to support the strained health systems and build self-reliance so when International Medical Corps leaves, the government can cope better with the needs of its population. Community health workers and traditional birth attendants are being trained, school feeding programs are being implemented and supplementary and therapeutic feeding centers provide the foundation for International Medical Corps’ programs.
Burundi, a small country in size, is densely populated with seven to eight million people. Food production, of mainly subsistence farming, cannot keep up with the population growth and degradation of the soil. There is almost no farm equipment, and in order for farmers to get their products to market, they must carry what they can on their heads or the back of a bicycle for miles. On average, each woman gives birth to nearly seven children, but many do not survive to adulthood. Currently 48 percent of the population is under 15 and a staggering 66 percent is undernourished. Life expectancy is dropping and presently lingers around 40 years so it is not surprising that Burundi ranks 171th, near the bottom of the U.N. development index.
International Medical Corps is initiating health programs in Rutana for some of the most marginalized people in the country. In one community we visited, almost 70 people were living in small shelters in southern Burundi. To step into their world is like stepping back thousands of years in time. These communities do not even have mud shacks to live in, but build basic round huts made out of straw. The men hunt small game in the nearby brush and the women must trek more than six miles to find clay to make basic pots that they sell for 20 cents.
We stopped at a nearby school to inspect the progress of a kitchen being built by International Medical Corps to provide supplementary feeding for school children. Many children are not able to attend school because they have to work. Providing food is one method to try to improve children’s health and increase the attendance rate.
We spent part of the morning packing up seven types of seeds before proceeding to a community where “model mothers” trained by International Medical Corps are relaying skills such as healthy cooking using local ingredients, disease prevention, and nutrition to groups of other mothers in their communities. When we arrived at a shaded area in the banana grove we were greeted by many smiling people who were singing and dancing. Soon we were handing out seeds, shovels and hoes to the women in the group. Surrounded by curious children, we felt an overwhelming sense of hope in the community.
Malnourishment, particularly caused by lack of protein, brings on edema in the feet, legs and faces of sick children, along with ghastly swelling as fluid builds up under the skin, turning it purple and blistery. In the therapeutic feeding centers there are hundreds of children who are dying or would be dead if not for the essential nutrient-rich milk provided by International Medical Corps. Children are referred to TFCs from supplementary feeding clinics. They are admitted if their height–to-weight ratio is low enough to warrant 24-hour care. Crowded rooms hold more than 50 mothers, each with one or sometimes numerous malnourished children in need of immediate attention. There is little in the rooms, often only a cot and a mosquito net and the constant cries of hungry babies.
International Medical Corps’ high recovery rate hovers around 84 percent. Malnourished children can be treated and sent home after a few weeks. However, children with malaria and other diseases that are harder to treat are often not brought in early enough. The most severely ill children are so weak they can barely move on their own. Their skin is stretched around bone, a protruding stomach and a disproportionately large head.
Muramvya
One hour northeast of Bujumbura, high in the hills among vast banana plantations, liess Muramvya. We drove 4×4 trucks along potholed dirt roads to mobile health clinics that provide outreach to the community. Using illustrated poster boards, International Medical Corps community health workers explain critical topics such as malaria prevention, sanitation and nutrition. Due to the high illiteracy rate, drawings and face-to-face interaction are the most effective ways to convey this information. A small mud hut houses a clinic where people can receive consultation and vaccinations. A line of brightly dressed mothers and infants extends far along the road; it will take most of the day for patients to be seen, so everyone waits patiently.
I was struck by how supportive the community is of International Medical Corps’ work. Our truck became stuck while trying to cross the dirt road.
Villagers surrounded us within seconds and began to push. When we rode along the same track 15 minutes later men were already fixing it. They smiled and waved as we passed by. I smiled back, grateful that human emotion transcends both language and culture and allows us to communicate basic emotions such as gratitude to all people.
Traveling in Burundi
Boys as young as five years old herd goats and cows by the side of the road. They are alone, working to help support their families instead of attending school. Everywhere you go you see people working in the fields. It seems as though every inch of the land is used. Something is planted every few feet on the side of the road. There are some cash crops like teas and coffee, but most of the land is used for subsistence agriculture. As we drive by, children reach out with stretched fingers and pleading eyes, hoping for money or something to eat.