Humbling life stories
& miraculous Moringa. . .

The week has zipped by. The hourglass sand is emptying faster as I enter into the last month of this stint.

The standard fare of beans and rice is excellent, but gets a tiny bit monotonous after two and a half months. For a variety of reasons (including celebrating the passage of health reform in the USA), it was decided that last Monday was the day to have impene (goat) for dinner. After clinic time there was major deliberation as to which one would be served. Brad was all set with the knife, but in the end Elvis did the deed. Dinner was a festive occasion!

A woman hobbled into the clinic barefoot with a large walking stick and a baby on her back two days ago. She reeked with the quintessential smell of infection and necrotic tissue. Brad examined her and discovered that her right breast was bandaged and saturated with a foul, green discharge covering a ragged, deep crater eroding most of the breast. Her 8 month old daughter, Misago (meaning the 11th child), is severely malnourished. They were “fast tracked” through triage and admitted.

Getting her and the baby “settled” took a bit of time; cleaning them, changing the breast dressing, initiating antibiotics, pain medication and vitamins for the mother and getting the baby begun on the standard malnutrition protocol of medications/vitamins and F-75 milk supplement. It seems as though she has breast cancer, requiring the need for surgery and X-rays of her hip for evaluation of possible metastatic bone cancer, neither of which we can provide here at VHW. Right now we will fortify her and get the infection under control and then refer her onwards.

Thanks to the help of Gerard as my translator, I have been able to get a quite in-depth history and hear some of her life story (as well as several other patients). She is 42 and the mother of 11 children. Her husband left her last year. Two children have died and she has left 4 children home alone with a nine year old in charge. She walked about 50 miles in the torrential downpours over two days to get here. Her tenacity, resilience and acceptance of suffering as her status quo is certainly humbling. I feel privileged to be involved in her care, helping her with her right to health care and elevating her dignity.

I have done more home visits this week, dovetailed with Will’s visits to home gardens in Kigutu. I love these times. We are really beginning to integrate the food security program with clinical care and nutrition for the patients and staff with highly nutritious Moringa which is very exciting. Moringa oleifera is a phenomenal “vegetable tree” which is grown on site. It provides huge amounts of beta-carotene, Vitamin C, protein (all amino acids), iron and potassium. The leaves can be cooked like spinach or they can be dried and crushed into a powder and added to cooked foods.
Will has given talks to the mothers in the malnutrition ward about Moringa and we are beginning to give it to the children. This is especially timely due to the cutbacks from UNICEF with the Plumpy Nut supplies. We are now sending patients home with Moringa powder and seedlings too. It is definitely possible that much malnutrition and disease can be prevented through the use of Moringa. Check out www.treesforlife.org to read more about it.

Two staff members, Peter and Mandela, are entering the International Peace Marathon in Kigali in May. It’s terrific to think that VHW, Kigutu and Burundi will be represented by these two remarkable athletes. I will be cheering them on from overseas.

There is a tradition here now at VHW that on the last Thursday on the month we have a soiree for all the staff to celebrate the birthdays which fall within that month. Last night we celebrated Evariste, one of our drivers. It was a fun night for everyone to gather, unwind and dance. This is definitely a special group of people for work and play!

Helen

Impene preparations


Impene ready for the fire


D and Misajo


Bosco and Will home gardens


Will and Bosco giving talk about moringa


Will with moringa powder for severely anemic boy


Mothers going home with moringa seedlings


Sisters


Mandela and Ferdinand doing laundry


Kigutu family home visit


Brad and Melino


Barack and Brad


Dancing


Helen with Hussein and Germaine



Another amazing sunset over the Congo

Amahoro, mwiriwe. . .

The torrential seasonal rains each day (Melino says hippos and elephants vs. cats and dogs) have been producing a lot of standing water everywhere, perfect habitat for mosquito larvae. Adults and children with cases of severe malaria continue to represent a huge portion of the patients admitted at VHW.

Last Monday Peter, Will, Brad and I walked to a neighboring village, Kirungu, for community outreach. We were accompanied by our armed guard Desiree (who had no idea he was going to be following the muzungus on a steady hike for four hours!). Many citizens had large pits from digging the clay for bricks right next to their houses half filled with rain water. No wonder malaria is rampant. We did our best to provide some education about the dangers of malaria. Luckily quinine is still a successful treatment and most people turn the corner fairly rapidly. Bed nets need to be distributed too. Over the weekend we had four malaria patients delivered by stretcher. It always amazes me to think of these people getting carried such far distances, lugged up and down these slippery tracks.

It was great to be out in the village talking to people (mostly women) about the access to health care in Kigutu. They are eager to attend the planned teaching sessions on home gardens and nutrition. They also seem eager to discuss family planning, though they were inhibited by the presence of children and men.

Preventative care, which is a bit of an alien concept, especially for children, was discussed. It was very gratifying that a father brought his healthy (utterly adorable too) twins in for “well child” checks on Friday after meeting them earlier in the week in Kirungu. We will return there soon. Peter is the perfect ambassador and guide.
Later in the week I accompanied our local Kigutu accompagnateur, Cecile, on her before sunset rounds. Seeing people in their regular daily routines vs. in the hospital is very appealing! I love being out and about in the community as people fetch their water from the pump, return home from the fields with full baskets on their heads; children play with balls made out of wadded up plastic bags and string and boys herding their cows home.

Many people know me now (and even if they don’t), there is a continuous litany of the standard greeting “Amahoro, mwiriwe“ (Peace, good afternoon) with firm handshakes as I walk the paths through the banana and cassava plots. It was sublime with spectacular evening Maxfield Parrish light with the background sounds of the drummers practicing and the children singing in the local church.

Cecile took me to a tiny mud hut with a woman in her 70’s (very old for Burundi) with extreme edema and ascites (fluid in her belly) lying on a fresh bed of grass outside her doorway. There were two lambs leaping over her head as she lay in a pool of sunlight. It was a serene image. Later she came to the clinic and Melino did a paracentesis, resulting in the drainage of 5 liters of peritoneal fluid which will make her much more comfortable. I look forward to following up with more home visits and time out in the community.

It was extremely gratifying to finally get a hand washing station with water and soap set up in both wards this past week. It’s certainly basic and simple, but nevertheless quite an achievement. Infection control at its best!

The malnutrition ward has been overflowing. It is so wonderful to see these children morph from frail, withdrawn waifs into plumpy, outgoing little characters over their time here, an average of 2 weeks. The mothers (or often grandmothers) become their own little tribe, forming a sisterhood of mothering as they care for their children. When one departs they all have a clapping sendoff as they walk out the driveway. When a new child is admitted I make a point of introducing the mother and child to the group. It’s a special place with Ada and Floride being the mother hens, keeping the milk supplied and the place clean.

A few of us had a weekend away in Buj. I had a swim in Lake Tanganyika which was a first for me. Brad, Will and Alex learned that eating ice cream, especially in public, is a sign of homosexuality in Burundi… though men holding hands and other public displays of affection aren’t seen as such.

I’m about two thirds of the way through my time…yikes….I feel as though I have barely made a dent in all there is for me to accomplish here on this stint.

Helen

Desiree guard

Adorable twins in Kirungu


Kirungu woman



Kirungu Mother and child

Peter 3

Cecile on rounds

Kigutu woman heading home


Downtown Kigutu

Melino drumming

Claudine's singing group


Hussein and grandma

Malnutrition mothers awaiting Melino


Morning rounds

Marie

Handwashing station by the ward FINALLY


Ice cream eaters

Lake Tanganyika swimmers

Ada, Helen, Floride


Newly admitted family
to malnutrition ward


Raining 'hippos and elephants'

Daily Rhythms. . .

The week has been a bit of a blur. The days unfold and are remindful of the ocean’s rising and ebbing tides. Every morning the patients pour through the gate towards triage as we are walking to do rounds in the malnutrition ward. It’s a quick assessment for the rest of the day’s “busy-ness”. The high tide peaks around 11:00 and by 5 PM it has ebbed, leaving behind full beds in the overflowing wards, a reduced supply of medications and a weary staff.

A 14 month old baby died over the weekend. She was admitted on Friday with malaria and severe anemia. Getting her fever down from 40.3 C (104.5 F) was challenging. Later she had respiratory distress and succumbed. It’s so sad knowing that a blood transfusion would have probably made the difference between her life and death. There is a severe national shortage of blood in Burundi and transporting patients to Rumonge or Bururi (about an hour away) is problematical. The day that we have blood bank capabilities here in Kigutu will be a quantum leap for VHW’s services.

Several of us had a “Mountains Beyond Mountains” hike on Saturday and did home visits to Clovis (the 4 year old burn patient) as well as to a gentleman who has diabetes and a successfully healed chronic leg ulcer. Clovis’s burn is healing so well. Brad brought back some Vitamin E oil for the final healing process. Upon our arrival his grandmother (who is really his surrogate mother), Liberatie, was working in the fields. Word was sent to her , via the grapevine, that the muzungus had appeared and she came running back with a load on her head. (I hate to think how far she came!) As per Burundian custom, we had to accept her gifts of food for us. As we were about to depart some children appeared with loads of firewood and started running away terrified when they saw us on their home turf. It was probably the first time they had ever seen a muzungu…never mind four of them. Liberatie called them back, laughing hysterically.

Telling time in Burundi is another difference requiring a bit of adaptation for us muzungus. Only daytime is differentiated into hours. We are so close to the Equator here, with the sun rising at 6AM and setting at 6PM, there is hardly any dawn or dusk. 7AM is 1 (rimwe), 8AM is 2 (ibiri), 9AM is 3 (gatatu) and so forth. The months are named according to the flow of the weather changes and patterns. April is “ndamukiza”, meaning “greet them on the other side or “greet them for me”…
since the rivers are flowing at high levels and people are not able to cross, they have to just yell across the water to those on the other side.

The highlight of the week was definitely the return of Bazile and Brad. It’s great to have them both “home”.

Helen

Patients arriving in the morning

Six toes


Helen hiker


Walkers at the top


Boys reading


Walkers with Clovis and family


Helen drinking banana beer


Wood carriers


Helen with Hilarie's auntie


Heading home back down the hill


Clinical staff welcome back Bazile and Brad

Hard Challenges: Umupfhumu, Hunger and Cutbacks. . .

It was another full-to-the brim week here in Kigutu! There was a veritable tsunami of patients arriving for consultations every day, as predicted, because of the relative lull in the action last week due to the bean planting in the region.

We had a series of patients arrive with infections, liver toxicity and cardiac complications as a result of visits to the umupfhumu (traditional healer). It seems to be embedded into the local culture that the uvula and the epiglottis cause ‘the shoe disease’ and that the xiphoid process (the prominent bony tip at the end of the sternum) causes the bone disease’. The traditional healers are thought to be able to prevent these horrible fates and are the ones to provide the healing via cutting as they “. . know the research”. They are all profess to be ‘experts’ on liver problems and other chronic diseases too. People seem to flock to them and are willing to pay them a lot of money (which they don’t have).

This week we admitted five patients who had serious problems as a result of the umuphumu’s care. There was a three week old baby who weighed three pounds and was not able to swallow any milk or breastfeed due to a uvulectomy the previous week; an 18 year old girl with a tumour on her foot (she had had it for 10 years) who had a severe infection after cutting; a 30 year old man with hepatitis B, with poisoning from herbs as well as an infection post removal of his epiglottis (he also has a chronic cough now trying to keep food and water out of his lungs); a 4 year old girl who is partially deaf as a result of repeated ‘throat cleanings’ and ear damage. She also has rheumatic fever because of the pharyngeal infection post epiglottis removal. Melino did an echocardiogram of her heart and luckily she has no damage. Lastly, a nine year old who has severe cardiac problems due to rheumatic fever (she’d had her epiglottis removed a few years ago.) Who knows how many people are suffering from complications that don’t make it to VHW. Last month we had a man with a severe penis infection due to a visit to the umupfhumu. The high risk of contracting HIV is also terrifying.

Melino has given talks this week to patients and their families as well as the accompagnateurs about the dangers of seeking care from the umufphumu. It’s an ongoing saga in health promotion. During the talks we show the audience our own xiphoid processes (yes, even muzungus have the ‘bone disease’!) to try and educate them that it is normal. It’s a challenge to find the balance of cultural sensitivity to local belief systems and reining in the life threatening practices of the traditional healers.

Two representatives from the World Food Program (WFP) arrived on Monday to speak with and evaluate the eligibility of all the patients in our HIV program regarding receiving food packets. The WFP has had recent cutbacks and now will only be supplying family food packets in Burundi to 5000 people this year compared to 6000 last year. As you can imagine, food and hunger are very touchy subjects and are potentially volatile. The reps stated that they choose to run meetings publicly for complete transparency and social justice. Confidentiality is not an issue. It was a fascinating process to witness and went smoothly.

They began down the list (about 100 people) calling the names one-by-one. Each individual stood or came forward and stated their case. Some were immediately checked off as a ‘pass’ and others not. It was interesting to note how the group got involved in the ‘yes’ and ‘no’ process. For example, one man stood and everyone yelled, “He’s poor, he’s poor!”…and he got a check and not the long cross out line over his name. Another fellow, claimed he was an orphan (one of the criteria for acceptance into the program), despite being an adult. There were immediate scoffs, jeers and laughter from the crowd and he was crossed off. People who were not present were represented by their accompagnateurs who were also advocates for people present.

UNICEF visited on Wednesday (a day earlier than we originally anticipated) and all went well. The two representatives were obviously very impressed by VHW. One commented that it was a ‘state of the art’ facility for Burundi. Their main message was that Plumpy Nut stock (the third stage nutritional supplement used for malnutrition) will be decreased for a variety of reasons (financial cutbacks a biggie) and should only be supplied to severely malnourished children who are in-patients.

UNICEF is shifting their focus more and more into a community based model with health promotion, food security and cooking classes to deal with the moderate cases. This will mean a huge change for us here, as we supply many with Plumpy Nut.

The challenges and hardships abound on a daily basis here in Burundi and I continue to be amazed by the good cheer, resilience and patience of these people. Their chosen names manifest their wonderful spirit….’Goodness’, ‘Nice’, ‘Good Luck’, ‘Happiness’, ‘Sincerite’, ‘Bonne Annee’ ‘Happy New Year’ (born on Jan 1st!) and ‘I Love’ are some of the people I have been fortunate to meet here.

Helen

Helen showing patients her xiphoid process


Melino showing patients his xiphoid process

Adult male with uvulaectomy
and epiglottisectomy

Three week old baby post uvulectomy

Foot tumor with infection
post traditional healer visit

Girl with endocarditis

HWW and Melino

Patient audience

gRooster gift for Melino

Bea having Plumpy Nut for the first time

Young mother

Women waiting for consultations