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Sean Healy in Burundi
Civilians in Burundi have lived through years of conflict – years in which infectious and parasitic diseases, especially malaria, have remained immense health problems. To meet some of the various health needs, Médecins Sans Frontières’ (MSF) work is diverse. Sean Healy, from Sydney, is working as a field coordinator in Kinyinya, a remote town near the Burundi-Tanzania border. Here he gives an account of the challenges involved of providing care to those who have none. "The place where everything ends" was the way Kinyinya was described to me before I got here: a forgotten corner of a forgotten country, where the tarmac stopped 25 kilometres ago, where there's no electricity, running water or telephones and certainly no law, where there are no other wazungu (whites) for miles around, the last place on earth an educated doctor from Bujumbura would want to go to. Prepare for isolation, I was warned. Well, it's true, but it's also a rank injustice. Kinyinya is certainly isolated: we're in a region called the Moso, basically on the Tanzanian plain and not in the high hills that mark most of Burundi, which is almost as far as you can get, geographically but also culturally, from the capital. During "la crise", the long civil war since 1993 which touched every family but which now mercifully seems over, the Moso was highly unstable, a battlefield, a rebel stronghold, and a place of regular movements, military and civilian, backwards and forwards, between Burundi and the large refugee camps in neighbouring Tanzania. It still certainly does lack the trappings of development: roads, water, electricity, you can't even get a mobile phone connection, much to the frustration of many of our staff who have to track 10 kilometres down the road to make a call. And it's bandit-ridden: every week, we receive the victims of bandit attacks in our hospital; even we have been victims of banditry in our own office. But this place is also one of people rebuilding their lives: each week dozens of families are coming back from Tanzania to start again. The Wednesday market is lively, and seems to be getting bigger. New houses, schools and churches are being built, with the help of international agencies who are starting to take an interest in this place again. The new president has promised to extend the tarmac to here and beyond; the former rebel leader counted this area as one of his strongest backers during the July elections, and this is one promise that just might be fulfilled. Wazungu are becoming more common; on one day, in town, I spotted the vehicles of the UNHCR, GTZ, Action Contre la Faim, the Swiss Demining Foundation, Caritas and the Norwegian Refugee Council. And, while the Ministry of Health has not been able to fill the post of hospital director for three years, we do have an educated doctor from Bujumbura on our MSF staff. And, despite the isolation, we chose to come here. The MSF project in Kinyinya is a large one: eight expatriates and more than 100 Burundians fully staffing a 100-bed hospital and four health centres, providing the only health care to a catchment area of 60,000 mostly very poor people. We're well-established: the hospital itself is a thing of beauty. Built by the French Cooperation just before the start of the crisis in 1993, it is an impressive structure, spacious, light and airy, with a magnificent view to the escarpment 10 kilometres north of us, and fully fitted with wards for paediatrics, maternity, internal medicine, an operating theatre, even radiography. The health needs of this region are nevertheless enormous. Yesterday, I spent the day in one of our health centres, in Kabanga, just a couple of kilometres from Tanzania, and the end of the road. The consultations were one after another a long chain of young women in their neon-coloured pagnes bringing in their sick babies. One woman came with her two-year-old boy, supine with malaria, which accounts for 50% of our morbidity here; 28 years old herself, the woman said this was her tenth child, six of whom have already died. The next, a five-year-old girl, brought in by her father this time, was suffering her fifth bout of malaria since May. The next, a two-year-old girl, had both malaria and a respiratory infection, our second most common morbidity especially now in the dry season. And the next little boy only had to wait 21 days into his life before getting his first respiratory infection. All of these patients we can and did treat, quite easily: we have ACT (artemisinin-based combination therapy) for the malaria, paracetamol for the attendant fevers, cotrimoxazole or amoxicillin for the respiratory infections. And at the hospital we can treat far more conditions – meningitis, tuberculosis, the opportunistic infections which come with AIDS – as well as surgery for the huge numbers of obstetric emergencies and traumas, and counselling and treatment for the victims of sexual violence. But there are so many of these cases, the queue never really ends. And there are still so many who don't get properly treated, who never come from the remote hills – or who do come, but far too late for us to be able to help them. It's frustrating to be here knowing what could be done with more – more medicines, more money, more doctors, more will from the government. And yet at the same time, we're doing what we can, demonstrating each day and in each medical act, that the people here have not been totally forgotten, at least not by us. MSF has worked in Burundi since 1992.
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