Word and Deed: July 2019

Zigama Mama logo, designed by Carlan

by Rachel

I've always been interested in the idea of public health. People have likened the idea of medicine in the developing world (or elsewhere) to pulling drowning people of of a raging river. Public health is going upstream to figure out why so many people are falling into the river in the first place. Of course, if all your time is spent saving the drowning, it's pretty hard to find the time to pull yourself away to take a walk upstream. Important and necessary, but challenging to prioritize none the less.

After six years here, Eric and I decided to take that walk. Ever since the first months here at Kibuye, I have been noticing a huge amount of uterine rupture (UR) cases. They are very rare in the US, but we have about 20 cases per year here (Side note for the medical folks: I looked at cases of UR from 2015-2017 and found 55, which is over 1% of our deliveries. !!?? Only about 50% of there are on uteri with previous scar. So we have a huge amount of UR on unscarred uteri, which is pretty rare in the medical literature. Harder to prevent for sure...). A big risk factor for UR is labor after a previous Cesarean section. Everyone in the health community "knows" this, but given broken systems and difficulty in education, many women who are at risk for UR continue to labor at home, in their villages, way after their due dates, instead of receiving a scheduled C-section or coming in to the hospital to deliver under surveillance. Some show up with three previous C-sections, in labor, and don't even know their due date. If only we could find a way to get these ladies to come in sooner, to decide if a C-section is the best decision, and to choose a date for that C-section, maybe we could prevent some of these cases of UR. At the very least, we can decrease complication rates of infection, hemorrhage, fetal distress, etc, which are all higher in women with emergent vs scheduled C-sections.

Enter, Zigama Mama. This is technically Kirundi for "protect the mother." Our Burundian friends say that's not exactly the way they would say it...but we decided to use the phrase anyway given its catchy nature! :) Our hospital is the referral site for 17 health centers in our district. Any woman needing a C/S or increased surveillance would get sent from them to us, which also explains why our C/S rate is about 30% of our deliveries each year (instead of the national average of 6%). The idea of Zigama Mama was to look at all of our C/S data from the health centers for one year, then do a training session for the nurses at the health centers. The intervention is simple: every woman with a previous C/S, even one, gets identified by the nurses, written into a register, and then she gets a "coupon" for a free ultrasound at Kibuye. While ultrasounds are recommended in pregnancy, they are cash pay ($5) and most women can't afford them. So, the free ultrasound is the incentive to come to Kibuye, where I can confirm their due date and decide if a C/S is indicated or not. If yes, I schedule it. If no, I encourage the women to come to the hospital (not the health center) for monitoring as soon as labor starts. That's it. We'll look over the next year to see if our rates of emergent C/S and UR decrease.

Training on Postpartum Hemorrhage, using resources from Laerdal Global Health

We had the initial training session last week. Honestly, I wasn't sure how it was going to go. Eric made up a schedule that involved a start time of 8:30. At 8:30 on Thursday morning, only one person (out of the possible 35) was there. However, people trickled in over the next hour and in the end, 16/17 health centers were represented! We presented the rationale for the program, the nuts and bolts, and then had several hours to do some training for the nurses on post-partum hemorrhage and neonatal resuscitation, as well as share a meal together in the canteen. It was great to see our Burundian doctors coming in to help out with the hands-on training programs.

We divided up into groups to practice techniques on a uterine model for treating PPH

Dr Ladislas, one of the Burundian docs on my service, also did a great job leading one of the groups

On Monday morning, I actually already had four ladies show up with their Zigama Mama coupons! I'm excited to see how this intervention can have a positive impact on the health of women in our district. There remain so many barriers to access to care, but hopefully, little by little, we can chip away at them.

The Zigama Mama ultrasound coupon

By Julie Banks

Zeke, Julie, and Liam

When you come to Burundi, one of the first things you will notice are the colorful clothes. Especially in our rural village of Kibuye, it’s quite rare to see a woman dressed in “western clothing.” Women normally have two pieces of fabric that make up their daily clothes. They wrap one piece around their waist as a skirt and the other serves multiple purposes: a shawl, a baby carrier, a towel to clean messes, a make shift sack to carry potatoes, and more.

The fabrics are absolutely mesmerising! Bright statements of joy radiate against a sometimes dry and dusty background.

It didn’t take long for us to want to join in with these beautiful people and try on these bright colors!

Greg, Anna, Alyssa, Heather, Keza, George, Abi, Madeline, Micah, and Susan

Fabric is sold in pieces that are 1x4 meters. It's a wax-covered cotton which has a slight stiffness and a nice sheen. The fabric supplies are constantly changing, so if you find one you like, you better buy it quick or you may never see it in the shops again!

These little shops are found in the town of Gitega and in the city of Bujumbura. Each shop is maybe 2x5 meters large where they sell fabric and sew on a few machines that sit outside.

Selecting your favorite pattern and colors is no small task – so many choices!

Shopping for fabric can be a little overwhelming as you have to negotiate the price (normal in this culture) and we often draw a crowd of curious onlookers eager to see what we are buying.

After we buy our bright fabrics, it's time to talk to our favorite seamstress, Mama Mugisha.

This sweet woman is Dina, but everyone calls her "Mama Mugisha" (moo-ghee-shah). She is an atelier or seamstress/tailor. Incredibly talented.

Mama Mugisha is so fun to work with. She is creative, confident, and highly skilled! I love scrolling through Pinterest with her asking, "Est-ce que vous pouvez faire ça?" “Can you make this? Can you do that?” She always says, "Oui! Je vais essayer!" “Yes! I will try!”

There are, of course, no thin paper patterns sold in nice little envelopes here. But Mama Mugisha can simply look at a photo or drawing, take our measurements, and then come back a week later with a finished product really close to, if not exactly, what we ordered!

Kayla designs the cutest clothes!

No patterns. No electricity necessary. Mama Mugisha's team works with sewing machines that are powered by a foot pedal – maybe like one you could find in an antique shop in the States.

Logan and I recently asked Mama Mugisha to make scrub tops for our physician supporters in the Missouri Association of Osteopathic Physicians & Surgeons. They wore them with pride while Logan spoke at their annual conference in April.

Missouri Association of Osteopathic Physicians & Surgeons

When I asked Mama Mugisha to make a large order of shirts for us, she clapped her hands in laughter and hugged me saying, “Now you are my little sister. You are family. Because of you at Kibuye my children can have an education and the people who work for me can send their children to school.”

So it’s a win-win! We and our friends get to wear these beautiful Burundian clothes, and she and her family (and her workers' families) are blessed in the process!

Me showing pictures of people wearing Mama Mugisha's creations to her husband. He was so thankful for us, and impressed with his wife's work!

From Kibuye kids to adults, we all love incorporating the local fabrics into our wardrobe! We try to have fun with what we wear and not take ourselves too seriously. Here are a few snapshots of us in our finest Kibuye Couture!