The road to Kigutu curls through groves of palm trees and arches over a series of steep hills. In recognition of the services provided by Village Health Works, the Burundian government is now resurfacing the treacherous road that leads up to our clinic. This level of government cooperation, nearly unheard of for non-profit organizations, is particularly meaningful for Village Health Works as this road was first created 5 years ago by the intrepid volunteerism of the communities we serve.

Windowless homes flank the road and house families of repatriated refugees from Tanzania. Many refer to the cinderblock homes as "TB boxes" because they seem better suited to spreading disease than providing shelter. With little land to farm, families turn to cassava without knowledge of its nutrient deplete content.

A woody shrub, cassava is grown on every inch of available land and often pokes its spindly leaves up alongside our road. Like the people of Kigutu, cassava is resilient and able to live on next to nothing; clinging to dusty soil and setting up residence on the steepest of grades.

In one field of cassava there are two crosses erected on the side of the road. They are barely noticeable and hardly cast a shadow despite being at least the height of a well-fed American. Our agronomist Gerard explains that they are a warning:

"It means someone has been stealing cassava here," he says. "If they keep taking it, the owner of the land will kill them."

This explanation is sadly ironic – either choice posses a risk.

All cassava is laced with toxic levels of cyanide. To be edible, the root must be soaked in water or fermented for more than 18 hours in order to decrease the cyanide content by even half. Though it’s not even remotely nutritious, it is the staple crop of almost all of the farmers in the surrounding area of Kigutu thanks to its sheer abundance and ease of cultivation. This problem has been compounded by the decreased fund of knowledge created by the recent civil war, as previously favorable agricultural practices were literally uprooted by massive internal displacement and uncertainty wrought by the protracted conflict.

Tragically, children who consume cassava as a singular source of food are chronically malnourished – 72% of the population is food insecure, 60% are malnourished, and 20% of children under age five at our clinic are moderately or severely malnourished. Adults, who suffer prolonged accumulated toxicity, present here at the clinic with endemic goiters or pancreatic calcification, which leads to tropical diabetes.

For many, the choice seems to be no food or the wrong food, and so in some ways these crosses are a symbol of the work we do in Kigutu and the focus we have on providing food security through education and training. Standing tall in a field of cassava, they are a reminder that our education and community outreach initiatives are also a mater of life and death.

The dynamics that undergird the malnutrition crisis in Burundi (currently ranked as world’s 3rd worst in the hunger index) also offer tremendous hope for what is often mistakenly thought of as a fatalistic problem. Village Health Works succeeds by partnering with the people of Kigutu to achieve long-term transformation and so, we are effectively treating even the most severe malnutrition cases in our clinic and our Food Security Program is helping to restore and vastly improve productive agricultural practices in this post-conflict society.