(by Michelle Wendler) 

Here's a glimpse into what shopping in one of the country's largest "malls" looks like.

You first need to navigate a 40 min drive from Kibuye to Gitega. The road is challenging in many ways, from livestock, to pedestrians, and many bikes. And everyone trying to avoid the many potholes and other cars and motorcycles on the road. 

Here are some pictures I've taken of people transporting along the roads:

Once arrived the "on foot" part of the adventure begins. There is no "parking lot" here. You can park along the road or in front of a little roadside shop and walk to the mall. Crossing the streets is always fun, with cars, bikes, pedestrians in a mishmash trying to avoid each other. Many horns honking, people yelling, frantic running when the right moment comes. If you are a white person, you can expect to hear many people yelling "muzungu!!" because it's so rare to see one here. I've actually never seen another muzungu in the market. 

Along the main road is the fabric district with many little shops selling bolts of African fabric and many people sewing using pedal sewing machines. 

Upon entering the mall there are many ground level little booths where people are selling many things, like shoes, beans, rice, metal objects, fabric, etc. Most of the clothing items are not new, but are second hand. The shoes are washed to look pretty good though. And the prices are right. A pair of kids shoes will cost around 20,000 fbu with is around $5. 

Once in a while you might have to dive out of the way of someone transporting fresh meat to the meat shop. Fresh meat is usually a freshly butchered cow skewered on a pole and being carried by two men as blood drips on the ground. 

If you are looking for clothing you climb stars to the second story of a two story building. I've often wondered the journey of each item of clothing. I've seen an item with a Marshalls clearance tag, then a thrift store tag. They ship these clothing items in large bundles tied in twine to Africa from all over the world. The 2nd hand items that couldn't find a home elsewhere are welcome here. Sometimes there are piles on the floor to look through, or neat piles folded on tables. Sometimes you can find shops that actually hang things with homemade hangers. 

Bartering is the name of the game. People will be yelling one price while the shop owner is trying to get a higher. I've found that I always need to go with a local who knows the actual price that things should cost...otherwise I'll pay 10x the correct amount. 

Another thing to get used to how they will try to draw you into their shops. Sometimes they will grab your hand and pull you in. But seeing kids and babies everywhere is something I enjoy. This is a culture that loves family and kids. The little ones will often stare at my because it might be the first time they will have seen a white person. 

The vegetable market is outdoor but covered and is situated along the street. I love the colors in this part of the market. Thankfully I don't have to come all this way to buy our perishable items because we pay a local to come and do a large purchase for our team once a week. Such a gift, especially with gas prices and availability being so problematic. 


Malaria, Mystery and Mitigation

 (from Eric)

One of the obvious differences in practicing medicine in Africa versus the USA is that there are diseases that you have to master here that you wouldn't know how to treat had you not come.  Foremost among these is malaria.  Despite a few locally acquired cases in Florida and Texas this past summer, malaria is basically unheard of in the United States.  At the end of medical school in the US, I had learned some about the disease, but only really on a theoretical level.  I had forgotten most of what I learned, and certainly had no practical experience.

Malaria parasite infecting a red blood cell

But on a worldwide level, this disease is huge.  There were about 250 million cases last year, with over 600,000 deaths, and 95% of them are in Sub-saharan Africa.  Malaria is transmitted by mosquitos that infect the blood, and it can cause lots of different complications in the brain, in the lungs, in the kidneys, in the spleen, etc.

Here in Burundi, for many years, malaria was my number one diagnosis.  As in, more than 50% of my patients were admitted with some severe complication of malaria such as kidney failure, severe anemia, or a deep coma.  Many of them died, but because of good treatments that are available, most of them could live and their recoveries were sometimes quite dramatic (and very gratifying!).  It's a complicated disease, and so it was probably the disease that I spent the most time teaching my medical students about.

Malaria is around all year, but it is also highly seasonal.  I think it was 2017 and 2018 that Burundi declared back-to-back epidemics (with 2019 numbers being quite high but no epidemic officially announced).  The number of cases was more than 80% of the total population.  Most everyone was getting malaria.  Many people got it multiple times in the same season.  Then, starting in 2020, the epidemic rates seemed to be decreasing.

Enter 2023: This year, we have had virtually no malaria.

We are now at the end of the would-be "malaria season" and yet the numbers never rose.  Less than 1% of our tests are positive.  I have no malaria patients on my service, and because of the significant contribution this disease makes to hospital census, for the first time since our team arrived, instead of a steady rise in patients numbers, hospitalizations are actually down.

Kibuye's head lab tech performing malaria microscopy

What happened?  Good question.  There are very effective malaria prevention strategies, including indoor residual spraying and distribution of insecticide treated bed nets.  There is a national malaria program that is hard at work, but as far as I know, they were hard at work even when Burundi was suffering repetitive epidemics.  Médecins Sans Frontières (i.e. "Doctors without Borders") provided a great service to our hospital for a couple years, paying for treatment of all patients hospitalized for severe forms of the disease. But it seems hard to understand how that effort would result in so much prevention.

Christianity refers to an idea called "common grace".  This is a characteristic action of God, who sends rain and sun on everyone, the evil and the good, the just and the unjust (Matthew 5:45).  Across the country, Burundi has experienced common grace in the reduction of malaria this year.  Long may it last.

It strikes me that this situation demonstrates two characteristics of common grace.  First, it is mysterious.  Why did this happen?  Is there a direct cause? Nothing leaps to the eye.  But understanding something is not a prerequisite for being thankful for it.  Second, it is easy to overlook.  Being thankful for the absence of something is not what any of us are good for.  Something amazing has happened to Burundian health this year, yet we are all prone to overlook it because it is something amazing that did not happen.  It gives me pause to think what other grace in my life might be mysterious or invisible enough for me to overlook it.