Can a Clinic Help Rebuild a War-Torn Nation?

Can a Clinic Help Rebuild a War-Torn Nation?

Can a Clinic Help Rebuild a War-Torn Nation?

Beginning with medical care and expanding to education and more, Village Health Works is on a nervy quest to rebuild Burundi from the ground up.


August 8, 2012, was a special day for Deogratias Niyizonkiza and a red-letter day for the community of Kigutu. Deo, as Niyizonkiza is known to everyone in Burundi, from the president to the adoring villagers of his colline, had been rattling around in an ambulance accompanied by an army commando, a curator, an emergency-room physician, a sociologist, two soldiers with Kalashnikovs and a literature professor (myself). That morning the minister of higher education had asked him to found a research institute, and by evening a national museum was in the works. Such happy developments provide a measure of hope in a country where the medical and educational infrastructures are in shambles. After decades of genocidal war and the colonialism that incited it, Burundi provides ample scope for a visionary reformer like Deo. Through his passion, drive and genius for community leadership, aided by the generosity of international donors inspired by his plans, it has taken Deo just six years to revolutionize healthcare in Kigutu. Now he is taking on education—and more.

Deo calls Kigutu “this elegant mountain,” though at first glance it looks no different from any of the forested peaks edging the Rift Valley of East Africa. Here, women in vivid drapery balance tall baskets on their heads as they walk under rainbow golf umbrellas. From afar, they look like statuesque color bursts gliding up and down red paths in the forest. Oil palms tower overhead; banana trees poke up like tattered windmills; cassava leaves float like magic carpets on implausibly slender stems. In this landscape, unspoiled by power lines or pavement, the human cost hardly registers. The ruddy pigment of the soil tints the shifts of children too poor to own a pen for school, never mind a toy. They subsist day to day, malnourished and uneducated. The ravishing beauty of the scenery induces a sinister double vision—not at all what Deo has in mind when he marvels at the elegance of this mountain.

Kigutu lies in southwest Burundi, a country of just 10 million souls, bordered by Congo, Rwanda and Tanzania. Picture a pocket of misery lost in the shadows of Heart of Darkness, Hotel Rwanda and Kony 2012. None of these mega-myths mention Burundi, but all of them tell its story. Conrad’s corrupt “emissaries of light” in the Congo behave no worse than the Belgian colonialists who ravaged Ruanda-Urundi after World War I. Hacking away at body parts and belief systems, the Belgians found it useful to encourage hatred between Hutus and Tutsis.

In 1962, national independence brought deliverance from the Belgians, but not from racial violence—until, in 1994, the massacres erupted that Hollywood memorialized in Hotel Rwanda. That genocide lasted four months in Rwanda; in Burundi it continued for thirteen years. An estimated 15 percent of the population was murdered or displaced, and every industry was halted except for Primus Beer, “la fierté burundaise.” The peace declared in 2005 included no meaningful reconciliation process, and today no fewer than forty-four parties compete in allegedly democratic elections. Precious little reconstruction has occurred in any but the wealthiest enclaves of the capital, Bujumbura.

Why is there no Kony 2012–style campaign drawing Internet millions to the rescue of this devastated nation, a country that still lies in ruins after wars that ended eight years ago? Where small children stagger home with gallon canisters of water or drop out of 100-student classrooms, to the relief of their untrained teachers? Where traditional healers make fortunes cutting the uvulas out of newborn infants without bothering with anesthesia or sterilized knives, and schizophrenics writhe on dirt floors, their hands bound behind their backs with meticulously plaited grasses? The answer is obvious: no one has heard of the place. Burundi is a disaster of mythic proportions lacking a myth. And with opinion-makers both in Africa and abroad insisting that tales of misery are not the way to write about Africa nowadays, it is unlikely to acquire one. Burundi needs a different sort of story altogether.

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Right on cue, Deo pulls up in the rattletrap ambulance. Since 2006, he and the people of Kigutu have been working on a new script. It’s called Village Health Works, and the theme is “Where there’s health, there’s hope!” Part Horatio Alger story, part The Mouse That Roared, Village Health Works is a nervy quest to rebuild Burundian society from the ground up. Beginning as a medical clinic, it has expanded to food security and job training. Its independence and holistic thinking have salience far beyond Burundi. Deo, a poet-dreamer, is not above the odd quip. “Ask not what you can get from America,” he urges his fellow Burundians; “ask what you can do for the world.”

Now 40 and a US citizen, Deo was a 21-year-old medical student in Bujumbura when war erupted in 1994. With the help of a wealthy student from overseas, he escaped to New York, where he lived rough in Central Park for months before artist Nancy Wolf and her husband, Charlie (the sociologist in the ambulance), took him in. (Pulitzer Prize–winning writer Tracy Kidder depicts Deo’s remarkable passage from street person to Columbia philosophy major in the bestseller Strength in What Remains.) After Columbia, Deo enrolled for a master’s in public health at Harvard under the legendary Paul Farmer, arriving in Cambridge on 9/11. Seeing his fellow students stunned and grieving, Deo spoke of the violence he had experienced. Among those present was a Malawian-American, Dziwe Ntaba (the emergency-room physician in the ambulance). The two resolved that day to return to Africa and make a difference. Five years later, they were launching Village Health Works.

In December 2005, Deo and Dziwe assembled a group of villagers to propose a plan for world-class medical treatment in Kigutu. By the summer of 2006, the community had mobilized to create a safe water supply and a clinic, which they proceeded to construct with their own hands. The need was obvious: the nearest hospital is twenty-five miles away in the city of Rumonge, its unventilated wards holding pens unfit for animals. Blood trails crisscross unwashed floors; patients and family members sleep together on squalid cots; IVs are administered in a dusty courtyard, perhaps to spare technicians the stink inside.

At the promise of a clinic, the villagers coalesced into a community. Living side by side in Kigutu were families who had perpetrated hideous crimes against each other during the wars. Deo shunted their rancor into the past: “We must work together,” he told them. “All people are the same when they are sick.”

At a public meeting, villagers agreed to donate twenty-five acres of communal land on the top of the mountain, their most precious possession. They also raised what for them was a staggering sum, 150,000 francs (at that time, $150). Women fashioned bricks out of the red soil and carried heavy stones on their heads to clear the roadway. Moved by their efforts, Tracy Kidder contributed funds.

The clinic took a year to build, after which an anonymous donor financed a staff residence and community center. Village Health Works was registered as an NGO, with an initial Burundian medical staff of three doctors and four nurses. Today, a stream of specialists pass through from Columbia and Harvard, assisting staff and observing how medicine answers the needs of the world’s poorest people.

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Among those needs, perhaps the greatest is human dignity. According to Deo, self-hatred and despair are literally killing Burundians. A Socratic treatment style has been developed in response. The doctors practice through dialogue, eliciting their patients’ opinions as earnestly as they offer their own. The contrast to the authoritarian dictates of village elders and traditional healers, still powerful throughout the country, could not be starker, especially for women.

A typical prenatal session, for example, is an interactive seminar between twenty mothers-to-be and Doctor Melino, a gentle giant in lab coat and stethoscope. “How many of you are planning to have your baby’s uvula cut?” he asks. Three-quarters of the hands go up. “Can you tell me why?” This is the first time many of these women will have spoken up in public.

“The baby will die if the uvula remains.” “Everyone in my family has the uvula cut.” “The elders say I must.” “My husband says I must.” “The healer says God wants the uvula removed.”

“How much will the healer charge?” asks Melino. The answers vary from 1,500 to 2,000 francs, a bit over a dollar. But this is a country where as recently as 2009, according to the United Nations, the gross national income per capita was $188.

“Other parts of the body become sick,” says Melino. “Will you let the healer cut them, too?” The women look uneasy. “That would not be right,” says one. “God made our bodies, and we must not destroy what God has made.”

“But God made our uvulas,” says Melino. “Why would God give us a body part, knowing it would kill us?” He pauses. “Listen to me. If you leave your baby’s uvula in and it becomes sick, come to me. I will cure your baby.” Some at the table seem convinced, but for every woman who listens, thousands are carrying their newborns off to healers. Melino’s own parents refused to have his uvula removed until, pressured by elders, they gave in when he was 8. Six men held him down on a table and forced his mouth open with a board as the healer did his work. His eyes roll at the memory.

Village Health Works treats malnutrition, malaria, TB, AIDS, worms, even leprosy, as well as hypertension, cancer and diabetes. Many conditions are heartbreakingly preventable. In a consultation room, a woman bares her back to reveal what looks like a full-sized breast, a huge fatty tumor that has been left to grow for twenty years. A 4-month-old arrives in critical condition, its fevered body covered in cuts administered to release evil spirits. When the cuts did not work, a local health center mistakenly treated the baby for malaria. Four days later, its fontanel bulging from meningitis, the child is near death.

Village Health Works has trained a small army of community members to make home visits, supervising drug regimens and teaching hygiene. Their own health improves in the process, since they can now afford food for their families. Malnutrition is endemic in Burundi, the major cause of death in children under 5. More than one-third of children are severely underweight and over half are stunted in height—all the more tragic, given that almost any crop can be grown here. Avocados and passion fruit drop off the trees.

The accepted explanation for malnutrition, as for every Burundian ill, is the war. Huge numbers fled their ancestral villages. The last of the refugees in Tanzania are now being forcibly repatriated—more than 33,000 in December 2012 alone. During the decades of flight and exile, agricultural and culinary traditions were abandoned. People ate what they could forage, and cassava, which grows wild, became a staple. Even after eight years of peace, many Burundians still eat nothing but cassava. The plant is poor in nutrients, and after the roots and leaves have been soaked to remove deadly cyanide, only calories remain. Men who drink the blindingly strong cassava liquor—and large numbers do—slowly accumulate cyanide in their bodies until a night of hard drinking tips them into coma and death.

Village Health Works agronomists have designed a food security program and helped organize gardening cooperatives. In April 2012, the first VHW Harvest Day displayed the produce of no fewer than thirty-five co-ops. The soap co-op is expanding into candle-making with wax purchased from the beekeeping co-op. The baking co-op is a thriving independent business, though Village Health Works consultants still help with new recipes, most recently banana bread, a hit with homesick Westerners. Fishery co-ops raise tilapia in a sustainable biocycle with poultry, and the sewing and basket-weaving co-ops provide job skills to women who are victims of sexual violence and family ostracism.

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With its modernization and growing influence, Village Health Works has been perceived by some as threatening. In 2007, the local Pentecostal minister showed up with a contingent of soldiers, claiming the clinic was performing forced sterilizations. Dziwe disproved the charge, but the hostility did not disappear. In 2009, the clinic’s pickup truck was ambushed by unidentified assailants, the driver shot dead before Melino’s eyes. The murder, which reached the op-ed page of The New York Times, caught the attention of a Burundian commando who had witnessed so many atrocities in his twenty-five years in the army that he could not understand why he had been spared. Village Health Works seemed like an answer, and he applied to be security director. Now, wherever the ambulance goes, the former commando and two rifle-toting soldiers ride along with it.

* * *

Just outside the clinic grounds is a primary school where no student has ever passed the sixth-grade examination leading to secondary school. Though the government claims to spend more than 20 percent of the national budget on education, the school lacks windows, electricity, textbooks, notebooks and pens. The roof blows off in the rainy season, and teachers frequently stay home.

The curriculum remains much as the Belgians left it: “history” means European history, and the national exam is conducted in French rather than in Kirundi, Burundi’s indigenous Bantu language. Kigutu’s children score unusually high on the Kirundi part of the exam, but competence in one’s native tongue does not take one far here. And if some teachers know French, few know English, a required subject since Burundi’s 2007 admission to the East African Community.

In July 2012, convinced that illness and ignorance are inextricably connected, Village Health Works organized a historic forum on education. The first two days were devoted to community debate, an extraordinary expression of participatory democracy involving 170 parents, students, principals and teachers. The upshot was a full-scale indictment of Burundian education, which the Village Health Works staff presented to government officials on August 1. The tension was palpable: an upstart provincial clinic was telling the ministry of education how to do its job.

I was one of the speakers—not an expert on African affairs, but a literature professor (soon to be riding in Deo’s ambulance). For decades I had been teaching Heart of Darkness, wading through postcolonial theory and debating the pros and cons of repatriating stolen artifacts in world museums. Suddenly, these issues did not seem so academic. How shocking, I exclaimed, that Burundi’s treasures are on display for Belgian children, when Burundian children have no museums of their own. “Not true!” came shouts from the audience. Undeterred, I described America’s struggles with its past—the rediscovery of Zora Neale Hurston, Toni Morrison’s eloquent exhortations to remember. I showed a slide of El Anatsui’s Kente Rhapsody, a contemporary masterpiece inspired by the weaving traditions of the artist’s native Ghana. “Will Burundians, ignorant of their heritage, be able to create masterpieces?” I asked. The applause was polite.

Deo took over. “If we do not do something about our schools, we will be guilty of intellectual genocide…. Let us show the world we care about our children, our future.” Discussion followed—bureaucrats droning statistics, politicians casting blame—but by the time Kigutu’s drummers closed the forum, officials had agreed that quality education was a right, not a privilege.

Days of phone calls ensued; then, at sunrise on August 8, the ambulance sped to Bujumbura for an appointment with the minister of higher education. Deo had barely begun his pitch for a model school when the minister interrupted. Permission for a school was too complicated, he said. He wished to authorize an institute for advanced training and research instead. The Kigutu Institute had been born.

It was barely 9 am. Elated, the company decided to visit the Living Museum of Bujumbura, the only museum in the capital. It turned out to be mostly a zoo, housing torpid crocodiles, poisonous snakes and a particularly nervous leopard. The inanimate elements of its collection consisted of the peaked baskets sold in every Burundian tourist shop and two mannequins draped in bark cloth. A troupe of feathered drummers solicited tips beside a full-size reconstruction of a chieftain’s compound.

Deo demanded to speak to the director. It was unclear whether such a person existed, but the country’s only known curator was in town, a refined man in his late 50s named Jacques Mafarakura. He offered to accompany us upcountry to the National Museum. The group piled into the ambulance for a journey to the ancient capital of Gitega. There we discovered a weathered building housing three rooms of rare photographs and priceless artifacts. The curator had preserved them through all the years of war and looting since independence. Deo asked whether enough objects still remained in Burundi to stock a proper museum, and the answer was a hesitant yes. “We’ll get some back from the Belgians, too,” said Deo, and Mafarakura grinned.

The institute and museum lie in the fundraising future, but the needs they will answer are too urgent to wait for buildings. The staff of Village Health Works is already visiting communities throughout the catchment area to discuss the importance of education and offering free after-school classes for teachers and students in English, French and IT. In February, a team of educators, myself included, will return to Burundi to teach Western music to Kigutu’s accomplished drummers and dancers, and attempt to learn their rhythms and movements in exchange. The dialogue is continuing, this time across oceans.

* * *

Deo likes to say that healing at Village Health Works begins with the first step a patient takes into the gardens. Lovingly tended by the commando and his community contingents, the serene lawns and avenues of flame-red flowers stretch out toward Lake Tanganyika, shimmering in the distance below. Beauty is not a blind for suffering in this place; it is medicine. Imagine the elegance of a mountain where everything conduces to health and human dignity. This is the story that Deo and his fellow Burundians are creating, and they are doing it not just for themselves or for Africa, but for the world.

Pay a sobering visit to another war- and disaster-ravaged country in Amy Wilentz’s “Letter From Haiti: Life in the Ruins” (Jan. 28).

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