Supporting Women with Care and Programs

As with so many inspiring women throughout the world, Burundian women continue to overcome even the most heartbreaking stories. Case after case seems to bare out a simple truth: in terms of global public health and development, it is women who create change. When there is a road to be built, bricks to be fired or land to be prepared for planting, it is the women of Kigutu who arrive first with babies on their backs, and stay until the work is complete. The women of Burundi have a resilience that is unmatched and a spirit that is unbreakable. 

But it’s not easy to be a woman in Burundi. In fact, on Mother's Day 2003, the United Nations ranked Burundi as one of the world's five worst places for women. Sadly, Burundian women’s lives have improved little in recent years. Women here face a one-in-nine chance of dying in childbirth, high prevalence of gender-based violence and little support for women's economic development, compounding the already challenging context in which all Burundians live. 

One such woman, Anne, recently visited VHW. She sits across from Dr. Melino, Head Physician, with her head slightly bowed and her fingers interlaced in her lap. Anne has been here to Kigutu before. A few years ago she came seeking prenatal care for her first pregnancy and was counseled to have an HIV test, to which she agreed. The test came back positive. The doctors provided her with emotional support and counseling, taught her about nutrition and hygiene that would help fend off opportunistic infections and gave her an appointment for a second prenatal visit to start Antiretroviral Treatment. This visit would be the time to prepare Anne for what it would take to prevent mother-to-child transmission; we asked her to come back with her husband. 

When she arrived at home, Anne told her husband that she had tested positive for HIV and that she needed to return to Kigutu for further treatment. Infuriated, Anne's husband instructed her not to believe what she was told by clinicians—he claimed to know, for a fact, that it was impossible for her to have HIV. He ordered her to never to return to Kigutu and even enlisted his neighbors to help him keep watch over her movements to ensure she did not disobey him. Understandably, Anne was too terrified to return to the clinic for fear of being beaten or killed. 

The Village Health Works staff noted her absence and tried to reach Anne through our local community health worker. Despite her efforts, we couldn’t reach Anne—it seemed she had completely disappeared. 

When it came time to deliver, Anne was taken to a public hospital where they performed a cesarean section for another obstetrical indication—without supplemental oxygen or proper sterilization. With her husband in the room, Anne could not tell her doctors that she was HIV positive, and no precaution of prevention of mother-to-child transmission was made. 

When Anne recently reappeared, nearly two years later, our staff had not forgotten her. And so here she sits, telling Dr. Melino that again, she is pregnant.

Upon learning of her second pregnancy she bravely confronted her husband, telling him that she was certain she had HIV. She insisted that if she didn't go to the clinic she and her second child would certainly die. We may never know why this time was different, but fortunately her husband consented to let her climb the hill to seek treatment. 

With the support of our community health workers and clinic staff, Anne will return home with ARVs that she will take throughout the remainder of her pregnancy. When she gives birth, precautions will be taken to ensure her baby is born HIV negative. These precautions will reduce the likelihood of mother-to-child transmission from approximately 30 percent to less than one percent. 

Life in Burundi is hard for everyone, but that burden falls hard on women in particular. In answer, VHW is putting a focus on maternal health by expanding our prenatal programs, gender-based violence counseling, women’s economic cooperatives, and our flagship Women’s Health Pavilion hospital that will open at the end of 2012. 

Names have been changed.