A Community Peace and Health Model
Our work will continually be at the nexus of providing quality and
accessible healthcare to our patients and addressing the underlying
causes of structural violence and inequality which are the seeds of
greater instability and conflict in Burundi.” - FWA Strategic
Addressing the root causes of conflict requires first analyzing what
creates mistrust and insecurity in a community. It then requires developing
an action model which meets the specific needs of that community.
The majority of
FWA’s founders and staff come from Kamenge themselves.
Drawing from their own experiences as women living in poverty in war-torn
Burundi, they developed a community peace and health model which they
believed would best meet the needs of people in Kamenge and work towards
This approach has four main tenets: community, comprehensive healthcare,
trauma, and women.
As stated in the introduction, Kamenge is a stigmatized community.
It is also a poor community. This has a specific impact on the delivery
of peace and health services.
Poverty means that
most of Kamenge’s residents cannot afford
to seek medical care. They will wait until an infection or disease
reaches advanced stages before seeking medical attention. Even then,
it often means waiting until the beginning of the month (when they
are paid) to seek services and perhaps until the beginning of the next
month to buy the necessary medications.
Despite the fact
that Kamenge has over 50,000 residents, FWA is one of only two clinics
with a medical doctor in the community. One of
the major concerns of FWA’s founders was that people would not
seek medical attention because it required walking to Bujumbura and
waiting all day (or days) at an overcrowded hospital to see a doctor.
This meant losing valuable work time and leaving children at home alone.
Therefore the FWA
clinic is located in the heart of Kamenge. This central location
means that people can easily access the clinic from
their homes, do not have to wait in long lines to see a doctor, and
can receive all necessary testing and medication at the same central
site. All of FWA’s services are also offered at little or no
many people in Kamenge do not seek health services, FWA’s nurses and staff also make regular home visits to track
the health of patients and their families. The staff’s presence
in the community outside of the clinic also helps identify other community
members who are sick or in need.
Comprehensive Health Care
All people have the capacity to heal and lead a healthy life, including
people who are living with life-long diseases such as HIV. However,
empowering people to live a healthy life requires providing comprehensive
medical and psychosocial support, especially when working in a resource
poor community like Kamenge.
At FWA, comprehensive
health care includes three integral pieces of work. First, it means
providing medical consultation, laboratory testing,
counseling, and medication dispension at the same community-based location.
Second, it means providing nutritional support through direct food
aid, gardening projects, and micro-credit loans to ensure that the
needs of both patients and their families’ are met. Third, it
means providing adherence support to help ensure that patients are “accompanied” both
physically and psychologically through the healing process. Currently,
this is done through home visits by FWA’s doctor and nurses.
FWA is currently expanding this
through the development of a community peace and health worker program.
FWA’s founders recognized that war had a deep psychological impact
on all of Kamenge’s residents at both the individual and community
level. Therefore, in addition to clinical counseling services, the
FWA clinic also runs community trauma healing programs, much like the
HROC program described in the article “The Story You Need to
These programs focus on helping people recognize their own trauma
and empowering them to embark on their own process of healing and reconciliation.
FWA has also developed trauma healing programs specifically for widows,
sex workers, HIV+ women, and survivors of sexual violence.
FWA emphasizes women’s health. As discussed in the section “Health
and Peace,” the impact of war and poverty on health especially
affects women. Systemic gender discrimination and inequalities mean
that women do not have control over their own health or bodies. Women
may not be able to convince their husbands to wear condoms or engage
in family planning; women living in poverty are also less likely to
challenge their husbands on these issues because of economic dependence.
Women’s health is also often considered secondary to men’s.
Many infectious diseases, like tuberculosis and HIV, require that patients
eat properly to heal and live a healthy life. However, in poor families
in Burundi, it is men who will receive available “milk, meat,
Taking these realities
into consideration, as well as the pervasive use of sexual violence
and the long-term psychological effects of Burundi’s “crisis,” FWA’s
founders believed that women needed a place where they were welcomed,
where their needs were prioritized, and where they would not be denied
treatment because of their gender or economic status. FWA does not
turn male patients away—in fact, many of our patients are men—but
FWA emphasizes the needs of women to ensure a systemic cycle of exclusion
is not continued.
four tenets of the community peace and health model allow FWA to
carry out its mission of providing comprehensive community-based
health care to women and their families, reinforcing women’s
capacities to achieve their wellbeing, and working towards the recovery
of peace and health in Burundi.