Working with Village Health Works in Burundi
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While in college, I knew that I wanted to follow a non-traditional path after I graduated. I wasn’t sure what I would do while abroad, but I hoped to find a way to work towards international development in a health care setting. Later in college, as my academic interests crystallized, I started to hope that I could find a way to apply my computer science background to this kind of work. I considered joining the Peace Corps, but eventually I found exactly the kind of opportunity I was looking for in a smaller independent organization.
Village Health Works is an American NGO in Burundi, a small African country just south of Rwanda. The organization started out in 2007 as a clinic founded by a Burundian who spent about half his life in the United States. Since then, the clinic has continually expanded its clinical services, while building agricultural, educational, and economic outreach programs around this framework.
I was inspired by everything I read about the organization. When I contacted them, I learned that they had been looking for an IT manager for almost a year. VHW couldn’t pay me, but they could provide me food and housing. So it was the Christianson Fellowship that paid for airfare and other costs associated with the position. Without the support of the InterExchange Foundation, I wouldn’t have been able to commit myself to this opportunity for as long as I have.
Before coming to Burundi, I tried to learn as much as I could about the country and the region. The country recently struggled through a 15-year period of civil war that destroyed a lot of its infrastructure. Culturally, Burundi is very similar to its northern neighbor Rwanda, and has grappled with racial conflict of a similar nature to the Rwandan genocide.
Most of the information that I could find about Burundi and Kigutu, the village where I would live, was simple demographic information. Big gaps remained: How would I interact with my co-workers? What would it feel like to spend all of my time in the confined space of the clinic grounds? How could I eat a diet of rice and beans every day? Would I learn to flourish in such a foreign environment?
I made a casual effort to learn Kirundi during the summer before I came to Burundi. I could only find one language-learning resource - a dense textbook distributed by the U.S. Foreign Service. I had trouble engaging with its prose-heavy teaching approach and its tinny speech recordings. After a few weeks, I stopped actively trying to absorb it. After all, I assumed that most of the population would speak French. French and Kirundi are both official languages of Burundi. And though I’m American, I’d studied enough French to be proficient in the language.
My first linguistic discovery at the clinic was a relief: nearly all of the 40 residential full-time staff members spoke French – and many of them spoke decent English, too. But I was shocked to find out that almost none of the patients spoke French. Our medical director at the time estimated that among the thousands of patients he’d seen, only 4 of them spoke French well enough to carry on a conversation with him. This worried me ideologically, since the official language of instruction in schools in Burundi, past the fourth year, is French. But it also meant that I was completely tongue-tied when it came to verbal communication with the patients and the non-residential staff.
For the first few weeks, I felt distinctly separate from the patients who came to our clinic. I wanted to tell everyone I met, “I care about this place enough to learn your language. Just give me a month or two, and I’ll know how to tell you that myself.” But the only way I could respond to the patients’ friendly, unintelligible greetings was to smile back at them, hoping they could see the earnest intentions that lay behind my wide-eyed confusion.
I redoubled my efforts to learn Kirundi. It was harder than I thought. I tracked down a different textbook and went through one lesson per day. I made flash cards, and convinced a handful of staff members at the clinic to make audio recordings of practice sentences so that I could refine my pronunciation.
After a month or two, I could string simple sentences together. I started to respond to greetings appropriately, and labored to make conversation during group roadwork sessions. On Easter Sunday, six months into my time in Burundi, I was overjoyed to find myself absorbing whole passages of the pastor’s sermon at church.
A year later I find that I can carry on very basic conversation. I am charmed by the number of road signs I can read and the snippets of conversation that I sometimes overhear among my co-workers. But in other ways, I remain insensitive to the nuance that Kirundi carries with it.
I can feel sometimes that my questions, posed in French or English, don’t make sense. In those moments, I still feel set apart from the people I spend nearly all my time with.I find my efforts to learn Kirundi to be characteristic of my broader, ongoing efforts to interact meaningfully with this country and its people. There is a marked sense of accomplishment, paired with a large, looming sense of all that remains unfinished here.
I came to Village Health Works to set up a database of electronic medical records. The implementation of this system was primarily motivated by monthly reports that the Burundian government requires of all health care facilities. Before the database was in place, simple statistical information about how many patients we had seen with particular diseases or symptoms was extremely difficult to generate.
The clinic used to shut down for a day or two each month to allow physicians to sit down with patient registers and cull through more than a thousand consultation records. They would spend hours counting the number of men, women, and children from different age groups and locations that fulfilled various clinical criteria. The system would also give us access to crucial, real-time feedback about our patient population and their particular needs. A summer volunteer started to build a database in Access before I got to the clinic. I arrived with a strong starting point in place. My first job was to make the system as simple and robust as possible.
I monitored data quality carefully and made changes to reduce errors in data entry. I adapted the interface so that it would more closely resemble the paper patient forms that we use. I created an instruction manual about data entry so that everyone would follow the same protocols, and I added new fields that could be coded in the system. After a couple months, when data quality was sufficiently high, we were able to switch over to using the Access database as a basis for reporting, rather than our patient registers. I wrote a program that would automatically compile information from the database into a single reporting document. Data that once took days to generate was now available with the click of a button.
The project was initially met with resistance from staff at the clinic. They weren’t used to computers; they worried about what would happen if the data was lost and felt much more comfortable keeping duplicate records by hand. For the first few months, all information that was entered into the computer system was duplicated in patient registers. However, over time, the staff has grown to appreciate the convenience and usability of the database.
Two of the clinic’s four physicians now do all of their own data entry while they are in consultation with their patients. Many more staff members have participated enthusiastically in training courses on computer proficiency. We at the clinic hope to phase out paper records entirely within a year or two, relying on concurrent, real-time data entry from every employee who gathers patient information.
During the winter I began to think about how to standardize our inventory system and integrate digital inventory records with our existing pharmacy consumption records. At the same time, I started teaching English classes and computer proficiency classes for staff and community members. We arranged an exchange with local secondary school graduates, who had graduated with a concentration in pedagogy.
The clinic offered professional training courses to any of these graduates who agreed to teach supplemental classes to sixth-year primary school students in preparation for their national exams. By the end of six months of twice-weekly classes, several of the secondary school graduates could type at a speed of more than 10 words per minute. Three were offered jobs on the basis of their computer skills, even though they had never touched a computer before these classes.
In September, I was promoted to Deputy Director of Non-Clinical Programs. Now I have the opportunity to think more broadly about how to sharpen the strategy of our organization. I supervise budgeting, procurement, and IT, as well as our community outreach programs in economic development and education. It’s a great professional opportunity for me to learn about management, and how to be sensitive in leading diverse, cross-cultural teams.
Over the past year, I’ve watched the clinic make meaningful steps towards addressing the inequity that surrounds us. I watched the government pave the road to our clinic. Now that the road is flatter and less rocky, taxis are willing to transport patients from the base of the hill to the clinic – cutting down the number of patients who must walk for hours to receive care. I’ve watched our agricultural programs flourish. As we train more women how to grow vegetables - and why that’s important - I see more vegetable gardens around the village, and fewer malnourished children. These women, in turn, recruit others to start growing a variety of crops and eat a healthier selection of food. As community members start to find ways of supporting themselves through the clinic, I see the standard of living increasing slowly in Kigutu. House by house, people are able to invest in corrugated tin roofs that keep the rain out much better than their thatched roofs ever did.
And momentum is building. Next year, Kigutu will build a modern women’s hospital, complete with surgical facilities, blood transfusions, and specialist care. I am proud to be a part of such a project, undertaken by a growing movement within this community.
Village Health Works has taught me a lot about how to think about the task of promoting growth within a community. One of my Burundian co-workers loathes the phrase “saving the world.” If the problems in African countries were easy enough for one person to overturn, they would be solved by now, he points out. It’s not as though Africa lacks its own scholars and statesmen. After spending a year in Burundi, this is perhaps the most important thing I have learned. No single person can be responsible for systematic positive change.
Movements, by their very nature, require the active participation of everyone they serve. As an American working abroad, I learned that my first responsibility was to engage with the people around me; to listen and defer when possible, to stage arguments, play games together, to speak their language, to tell stories about my own life. And then to figure out, together, how we can all make each other’s lives a little easier and happier.
There’s a retort in Kirundi that asks if you are an imbogo or an imboga – that is, a buffalo or a leafy, green vegetable. In Kigutu, I’ve earned the name imbogo for my volleyball playing. We play regularly on a flattened patch of earth, crying out in celebration or complaint after every point. The games are both heated and joyful, typical of our approach to most endeavors in Kigutu.
When I leave Kigutu, it will be with a spirit of an imbogo, a warrior, a person a little bit more attuned to what’s out there in the world. Thank you, InterExchange, for supporting me at such an important juncture in my life. As I continue my work at the clinic, in anticipation of soon transitioning into related engineering work in international development in the United States, I know that I would not have had an opportunity to launch a career focused on global health or to have rich experiences in a culture so different from my own without your help.
By Jessica L.Jessica volunteered in Kigutu, Burundi with the help of a Christianson Fellowship, from the InterExchange Foundation.
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