helen weld public health

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