By Gerard Skerett and Melchiade Ninganza
The vast majority of Burundians live in rural communities and more than 90% of the population engages in subsistence farming. Traditionally Burundian society is patriarchal, where men hold positions of power; men are often considered heads of the family and the community.
Women have few rights under Burundian law. Land is always inherited by male children and when a woman gets married, she lives on her husband’s land. If her husband dies, there is no guarantee that the woman will be allowed to remain on the land as her husband’s family has the right to evict her. Much of the burden of work also falls to the woman of the house: cultivating the land, preparing food, and fetching water and firewood, often with a small child on her back.
In Burundi, some of the most disadvantaged women are repatriated refugees. In particular, those returning to the land of their parents often have to endure conflicts with other siblings, who feel that the land should only be occupied by the brothers in their family.
Vumiliya Juliette is one woman who found herself this type of situation. Fortunately she found help through Village Health Works, where she now works more than four days a week. Juliette is 31 years old and is from the town Mugara, just four kilometers from Kigutu. She is actively involved with VHW as an elected leader of an agricultural cooperative, an agricultural extension worker, and a member of the women’s weaving coop. She has two children, six and nine years old.
Juliette’s parents fled to Tanzania during the civil war in Burundi. She grew up and lived most of her life in Tanzania until 2010, when, after separating from her husband, she returned to her hometown of Mugara with her two children. Upon her return, she discovered that another family occupied part of her family’s land, a common problem in post-conflict Burundi. Unable to resolve this land issue, she accepted that she would have to make do and grow food to support her mother and two children on the remaining small portion of land.
Soon after her return, Juliette became very ill. Her mother had heard about VHW’s health center and organized for her to be brought there for treatment. After extensive testing, she was diagnosed with HIV, which she suspects is the result of her husband’s infidelity before their separation. For three months she was extremely ill and stayed as an inpatient at VHW while she was being treated. Thankfully, she made an excellent recovery, though the realities of life with insufficient land to support her family continued to take their toll.
HIV medication is provided free of charge at VHW as part of a program in conjunction with the Burundian government. One day, a few months after Juliette returned home, she was at the VHW site to collect her medication. While she was there she noticed a crowd of people sitting in a classroom set up in the community hall. She asked one of the attendees present what was going on, and discovered that it was the first day of a six-month training program in agricultural techniques and nutrition. She approached the staff and inquired about the program and how to become involved. It seemed as though luck was on her side this time, as there was a place available to begin there and then, and so she joined the class.
After six months of weekly training, Juliette joined a group of people hoping to set up a VHW supported coop, in which people pool land and labor to grow crops and raise livestock. After a few months, an election was held among the members to select a leader, and Juliette was chosen for this position. VHW supports these coops by providing training as well as supplies, such as seeds and fertilizer.
The civil war in Burundi wiped out much of the country’s livestock, resulting in a shortage of animals available for breeding. To address this challenge, VHW provides a variety of animals such as goats and pigs to coops that demonstrate a high level of commitment and ability in agricultural ventures. Juliette's coop was successful in securing this support and received 20 goats in September, 2013. Since then, 7 baby goats have brought the total number to 27. The coop has nine members, mostly women. Each coop must always keep 20 goats from which to breed. This means Juliette and her fellow coop members must wait a few more weeks before the families can each take a goat home. Some of the families will choose to sell the goats for profit, while some will keep it to breed on their own family plot.
Based on the knowledge she gained in the training program, Juliette applied for the position of Agriculture Extension Worker at VHW. This role involves building knowledge of agricultural practices and nutrition and then disseminating that knowledge into neighboring communities by organizing education sessions. Before beginning her training, Juliette mostly grew cassava, a staple food in Burundi, despite being quite malnutritious. An overdependence on cassava has been identified as a cause of malnutrition across the country. After training, Juliette began to grow a more varied crop of vegetables, and now her family benefits from a much more diverse diet. Agricultural workers devote a lot of time to their work; to compensate for this, they are paid a stipend of 30,000 Burundian francs per month (about US$20). Juliette is extremely busy, working as she does with two coops, as an extension worker, and not to mention, bringing up two small children as a single mother. The monthly stipend from VHW is guaranteed income for Juliette's family, and has made a big difference in their lives. Juilette has been able to buy clothes for her children and to plan for the future. Each month she uses some of the money to pay others to help maintain the crops on the small piece of land near her house, but she always makes sure to put aside 10,000 Burundian francs, which she saves with the hope that she will someday have enough money to buy some land for her children.
Recently, a weaving coop was formed with VHW's support. Women have been learning new skills and now have an opportunity to make additional income. Juillette has enjoyed becoming involved in this coop as well and learning new skills. She hopes that with time this endeavor will give her another source of steady income for her family.
Of the challenges faced by women in Burundi and of her hopes for the future, Juliette tole us that the biggest struggle has been shouldering such great responsibility alone. She says her life has improved with a lot of hard work and a little help from others and she hopes that as her children get older, she will be able to provide them with an education so they can have a good life and be happy.
Training Community Health Workers to Fight HIV
By Gerard Skerrett and Melchiade Ninganza
Deo Ngendakumana lives with his wife and two children (5 and 2 years old) in the town of Karonda. He is one of VHW’s community health workers (CHWs) providing care for approximately 500 households. While CHWs are not trained to the same standard as doctors or nurses, they do receive basic medical instruction that helps them provide much needed assistance to our community. Deo received his training from Village Health Works, where he learned how to recognize symptoms for illnesses like malaria, tuberculosis, HIV/AIDS, malnutrition and skin disease. When people who are ill go to Deo for help, he refers them to VHW’s health center. Deo gives advice on issues like family planning, and helps HIV and TB patients by collecting their medications on a monthly basis, and ensuring adherence to treatment. He also makes regular rounds of his community’s households and provides routine check-ups and advice.
Deo was diagnosed as HIV positive in 2002, while he was living as a refugee in Tanzania. He told us, "When I was first diagnosed with HIV, I lost all hope of living. I really thought I would die soon. Then I had some training and I realized that with the right treatment I could live with HIV, and I had hope about life again." Deo has since done all he can to learn how to live a long and healthy life with the disease, both as an individual and as a community health worker. Good nutrition is essential, he told us. It’s important to have not only enough food but also the right kinds of food to stay healthy. Accordingly, Deo grows much of his own food, including bananas, beans, maize, amaranth, eggplant, and tomatoes. He tells us that one of the big challenges he faces in Burundi is poverty. While he works hard on his farm to ensure a nutritious diet, he has learned from his CHW trainings and personal experience, that it is very important to conserve energy and get plenty of rest in order to prevent his condition form deteriorating. Deo says it's a constant struggle to find the balance between these conflicting pressures.
Deo is well respected in the community, particularly through his work as a CHW. He feels a lot of compassion for those who are suffering, as he knows what that is like. Among the patients he supports, 22 are HIV positive. Ndiho (pictured below), is a 50-year-old woman who was diagnosed with HIV in February. Deo collects Ndiho’s medication each month from Village Health Works, and delivers it to her. He then helps her with a plan to ensure that the tablets are taken as prescribed. The ill effects of HIV can be well controlled in many cases. A properly administered medical regimem can prevent the disease form deteriorating, and even reduce the density of the virus in the carrier’s blood, helping to prevent transmission. Ndiho lives more than 10 kilometres from VHW's clinic. If it weren’t for Deo’s asssistance and VHW's community health worker program, she would have to hike for a full day’s length in order to collect her medication.
VHW works with the Burundian Government to provide all HIV-related treatment free of charge. This includes consultations, screenings, blood tests, follow-up visits, and the long-term supply of medications.
Strength In What Remains Book Review in The Guardian
Strength In What Remains was recently reviewed in The Guardian. Thank you, Marianne Jago-Bassingthwaighte for your insightful review and for spreading awareness of VHW's community driven development initiative!
Ms. Jago-Bassingthwaighte, a lecturer and research fellow at James Cook University's Centre for Disaster Studies, writes, "What lessons can foreign aid take from post-genocide Burundi? This is not the question that Tracy Kidder's Pulitzer Prize winning novel asks, but within the narrative of Strength In What Remains there are important lessons in development effectiveness. For Deo, a recovery from trauma of his past has fueled his unrelenting pursuit of his childhood mission to build a village medical clinic in regional Burundi. His story is riveting and profoundly moving and the success of the clinic-- Village Health Works-- is among its most rewarding aspects."
Read the full book review here: http://www.theguardian.com/global-development-professionals-network/2013/oct16/book-review-strength-in-what-remains.
A Graduate of our Women's Agricultural Training Program
Eugenie is 49-years old and HIV positive. She lives in Nyanza-Lac commune, Makamba province, about a 2-hour mountainous hike away. Despite the distance, Eugenie attends VHW’s community service activities every Friday. In doing so, Eugenie learned about VHW’s women’s agricultural training program (WATP) and joined the program shortly after. Eugenie attended the Tuesday class for six months and recently graduated from the program.
Eugenie now tends to her own home garden, where she grows nutritious vegetables that have significantly improved her and her husband's health. Eugenie also participates in one of our agricultural cooperatives. She enjoys putting her new skills in nutrition and sustainable farming to work. We are very proud of Eugenie!
Eugenie asked us to share her experience at VHW. Here is her story in her own words:
“Every Tuesday for six months I woke up at 4 am; my husband accompanied me until the paved road where I took a bus, which let me off at a 1h30min walking distance from Kigutu. It was hard but exciting exercise and I’m witnessing now the results. My husband used to have a problem with his feet and the doctor told him to wear shoes every time he walked outside. He was addicted to cassava bread and meat, and never ate vegetables or beans. But after studying the importance of a nutritious diet, I shared with him my knowledge and he began to eat vegetables and his life improved overnight. I’m very proud of having attended the course. God helped me and I never got sick during the training."
Global Challenge Conference
This June Deo will be a keynote speaker at the Global Challenge Conference at Wheelock College in Boston, MA. Learn more about the conference and the topic of Deo's upcoming talk here: Wheelock Global Causes
Fun Run for VHW
By Finn Jackson
Jardin Public, Bujumbura
On March 17th, St Patrick’s Day, we organized a Fantastic Fun Run for Village Health Works in the Public Garden of Bujumbura. I had been wanting to run a race (like a 5K) but couldn’t find one in Burundi to participate in. After visiting the VHW clinic with my family in January, I decided to organize a run myself and raise money for a good cause at the same time. One day I shared the idea with one of my teachers at school (the Belgian School in Bujumbura) and he wondered if the school could help. To get the word out both inside and outside of Bujumbura, we set up a website on Crowdrise.com where people could learn about the run and donate. I also spoke to the kids at the school and encouraged them to participate. My brother Liam is a really good artist so he drew posters for the event and hung them around the school.
International Musicians Visit VHW
By Wendy Steiner
Health is impossible to achieve in the absence of education, and Burundian schooling, like so much else in this devastated country, is in a desperate state (#1, 2)
In the summer of 2012, Deo unveiled a vision for a model school, the Kigutu Academy, which would provide Burundian children with a world-class education. His deeply humanistic conception calls for music as the heart of the curriculum. In the Kigutu Academy, every child would develop the complex learning skills of listening, concentration, obedience, and cooperation through the joy of making music.
Margo Harrison MD, MPH, New York Presbyterian Hospital, Columbia University Medical Center, Department of OB/GYN, PGY-3
It was such a short trip. So short that I’ll admit many of my thoughts revolved around anxieties related to going back home. But there is one thing that impressed me in Burundi. Not the absolute majesty of the area—the lushness of the land whose florescent green skin, tricking the mind into thinking it was thick and jungley and forever productive, was actually thin and scarred and gave the eerie feeling of a five o’clock shadow that could, and might, be shaved off at a moment’s notice. Not the iridescent sunsets that I tried night after night to capture from the top of a hill, suggesting that the richness of Africa was something that would always be a treasure rife to be pilfered by a mzungu. Not the poverty, though that was something that puzzled me incessantly, only highlighting my own ignorance by the fact that everyone else around me seemed to understand it so fully. It was not the swollen ankles of the malnourished, the burned faces of the epileptics, the feet of children swollen into unrecognizable water balloons of puss waiting to be popped by an errant bone, or the tantalizing sensationalism of millions of stories of terror and trauma buried not so deeply in the subconscious of every single Burundian. What makes me a slightly different person from the one who was buying a chai tea from the Brussels airport Starbucks for $4.75 at 6:15am on the way to Burundi, and the one who bought the same thing at 7:30am on the way home, was their eyes.
A Visitor to VHW
Shared impressions by Sarah Bennison Machiels
"Wow, another amazing day. We started the day going back to the Village Health Works clinic. Today was the day when the community comes to volunteer, and the women's cooperatives were working. In addition to the clinic, as part of community development, VHW runs about 50 women's cooperatives - women are making baskets, sewing, landscaping, and as they work together in small groups they talk to one another, building community. This is a big part of the healing process in this country that has experienced so much tragedy and violence. I have been trying to really understand when the war began and ended, and it seems that it did not really end until 2007. This means that a whole generation of children grew up in this conflict, and many who expatriated to Tanzania are now being forced back to Burundi with nothing. The sense of devastation and grief experienced here is still very tangible, even amidst the beautiful smiles of the people and their friendly, gentle nature.
In early January of 2011, we admitted Cynthia—a 16-year old young woman from a nearby village—to our health center for treatment of tropical diabetes and severe malnutrition. Topical diabetes is caused by the calcification of the pancreas due to cyanide poisoning, a condition all too common in communities where cassava makes up the bulk of the daily diets. Roughly 82% of the population in our catchment area has a diet likely to be only cassava due to lack of knowledge about other types of food.
At the time we saw Cynthia, she had severe marasmus, with hair loss and changes to her skin, and also a blood glucose level of 544 mg/dL (normal adult range is closer to 100 mg/dL). We hospitalized Cynthia and were able to balance her required dose of insulin with therapeutic milk, which contains sugar. While her case was clinically quite challenging, our staff provided consistent, quality care and in time she improved enough to go home.
After she was released she took insulin for four months and her blood sugar stabilized. Cynthia became a part of our Women’s Agricultural Training Program. She gained access to training and learned what to eat and not to eat. After four months, she was able to stop taking insulin, but continued to come to the Kigutu health center for follow up visits and her blood sugar remained stable.
Today, Cynthia remains in good health without insulin. Our clinical team has determined that through initial treatment and ongoing dietary maintenance (including no eating of cassava) her pancreas has been able to recover and once more produce the appropriate amount of insulin.
While she was here for follow up, I showed her a picture of herself at her first visit, and she was surprised, saying “I was almost dead then, but now Village Health Works’ has given me back my life.”
By Dr. Melino Ndayizigiye, VHW Clinical Director
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What does 'Back to School' Mean in Kigutu?
At Village Health Works, we’re well aware that education is important in realizing good health. So, when the community invited us to become more involved in education throughout the catchment area, we agreed enthusiastically. We believe education is vital to our mission to improve the health and well being of our community.
Village Health Works is deeply committed to working with the community and developing projects based on their ideas and needs, and our education projects are no different. This week, we held a three-day education conference at our Village Heath Works community center in Kigutu to discuss the ongoing challenges related to education and identify possible solutions. Some participants walked several hours to attend, and excitement buzzed around the campus the first two days as over 170 students, teachers, parents and principals came to our center.
Celebrating International Day of Cooperatives!
International Day of Cooperatives
By Anna Chiu and Claire Inarukundo.
Earlier this year, I traveled to Burundi with my new husband who was going to work in the clinic at VHW. I was determined to come along and help out in some way as well. Coming from a small business and product development background, I wasn’t sure exactly how, but luckily for me, I met Claire on my first day in Kigutu. Claire is the Business Manager of Economic Development at VHW, and has helped organize various women’s cooperatives, many whose members have been victims of gender based violence. In these cooperatives, the women are provided with specialized skills training, employment, and a nurturing and safe environment where they can meet, collaborate, and hone their crafts.
Hope For Healing - Update
Last time I was in Burundi when I was walking through the clinic, Dr. Melino pulled me aside and asked if I wanted to see a particularly troubling patient. When we got to the exam room door he stopped.
Hope For Healing
Iranezereza is the fifth child in her family. She was born on February 15th, 2012. Three weeks after, she developed an abscess on her chest. Her mother took her to an area health clinic where they gave her an IM injection for fever and told her to go back home without the treatment she required.
Baskets & Burundi: Honoring Mother's Day
Originally from Gitega, Gloria joined Village Health Works as a weaving trainer in June of 2011. A single mother, Gloria has been supporting herself and now, her young son, by weaving beautiful baskets since she was 16 years old. Gloria learned her craft from her mother and aunt, secretly at age six. From bracelets to baskets, Gloria’s designs share a respect for tradition and a willingness to experiment. Today, she is excited that her skills will help others improve their conditions.