ZM Part II: Into the Community

by Rachel

At the risk of inundating all of you with more Zigama Mama news (see here for part I), I wanted to continue to share the next part of the story with everyone.  When ZM was set up, part of the program was not just training nurses and doing ultrasounds/scheduling C-sections, but actually going out to each of the 17 health centers in our district to make sure the program was going ok, requirements were being followed, and collecting some data sheets from each center.

I've actually been really excited about this part.  I've come to realize that in my six years here in Burundi, I have become very much a creature of habit.  I used to think of myself as somewhat adventurous, but now I go to the same places and do the same things every day.  I shop in the same one store, I take the same route to Bujumbura, I visit the one tourist destination by us (the waterfalls), I walk the same path to the hospital every day.  Even in Buja, we visit the same restaurant, the same grocery, the same hotel with swimming pool.  Part of this is finding the thing you like and sticking with it, part of it is that there's just not many new places to go or opportunities to go there.  Or that everything starts to look the same, and you wonder if it's worth the effort to keep exploring.  But the health center visit was a chance for me to actually venture off the beaten paths (sometimes literally) and see a totally different aspect of life here.  Months went by with many cancelled trips and I started to despair that these visits were ever going to happen...but as usual here, all of a sudden one day last week the pieces came together and the next day I found myself in the hospital truck with one of my OB nurses and the district health officer and we were off!

We are located in Gitega province, right in the middle of the country.

For those of you who don't know the system, Burundi is divided up into provinces, much like states in the US.  We're right smack in the middle, Gitega province (which is the most populous overall, according to Wikipedia at least).  From a health standpoint, each province is divided up into districts, and each district has its own hospital.  So, we are Kibuye district.  Then, each district is divided up into communes, and there are 4-5 health centers spread across each commune.  We have 4 communes and 17 health centers in our district.  Health centers are mostly like outpatient clinics, except that they will do "small surgeries," occasionally admit patients, and all do basic maternity care--prenatal visits and deliveries.  Each health center will refer their complicated cases to us at Kibuye Hospital, and our ambulance is responsible for going out to each health center to pick up the transfer, no matter what time of day or night.

The first thing that impressed me was the actual travel to each health center.  We were on paved roads for the first 5-10 minutes of the day and then spend another hour on dirt roads, usually smooth but occasionally a bit hairy given the recent rains, before we arrived at the first health center, Mahonda.  So, driving a decent vehicle still took over an hour from the hospital to the health center.  Most patients are not in decent vehicles--they walk, take bicycles or small motorcycle taxis, or sometimes ride in a rickety-looking station wagon-type taxi.  Thankfully, women is labor who need a transfer get to ride in the ambulance, but still...if the transfer is because she needs an emergent C-section or the baby is in distress, there is no quick way to do this.

Road leading to Mahonda health center

Road leading away from Buriza health center

The second thing that impressed me was the actual center and staff.  They have a hard job--located in the middle of "nowhere," seeing sometimes 100 patients a day in a much more resource limited setting than Kibuye, with no doctors to ask advice from.  The nurses need to be able to do suturing, wound care, deliveries, general medicine and pediatrics, and then figure out who needs to be transferred vs what they can handle themselves.  And they know that they can call an ambulance and at minimum, it will be over an hour before the ambulance shows up...if it's not out picking up a patient from a different health center first, or even worse, broken down and out of commission for days or even weeks.

CDS Mahonda staff, along with my OB nurse Moussa and the district health officer, Melance

CDS Buraza, one of the "super" health centers in the center of their commune

CDS Buriza, the newest health center in our district (opened by the president a year ago in August)

Finally, my third observation was just a reminder about how hard it is for my ladies to access care.  Even with free care for pregnant women, and community health centers.  Even with Zigama Mama offering free ultrasounds and consultations.  There are still barriers.  The nurse at Mahonda told me that patients have been refusing to come to Kibuye for a free ultrasound because it still costs 16,000 Fbu in transport costs to even GET to the hospital (reference: around $6 roundtrip.  also reference: for our househelpers, who make more money than the average Burundian, this would be about 4 days' wages).  This is on some level very discouraging--we remove one barrier only to discover that there are so many more still to be surmounted.  But on another level, little by little, barriers ARE being removed.  I was excited to see that each commune has a special, "super" health center being developed, where the government is committed to posting a midwife and improving training protocols and available medications for mothers and newborns.  I am happy to see that, even despite distances and transport cost, over 200 women have decided to make the effort to come in to Kibuye for a free ultrasound and consultation.  I am encouraged to see many nurses and other workers committed to providing health care in challenging places without many resources available to them.  And I hope our program and visits are encouraging to them, too.  To the nurses, to the women--they are seen, they are heard, they are loved.  Someone cares enough to try and make their lives a little bit better.

Thanks to all of your for your support and enthusiasm for our project.  I look forward to seeing its impact continuing to unfold over the next year, and even beyond.

Beautiful terraced hills on the road to Buriza