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On the Long Road: Burundi
By Alexandra Douglas and Dr. Alexia Nibona

Introduction

War and Health

Health and Peace

A Community Peace and Health Model

FWA’s Philosophy

On the Long Road: DRC
By Alexandra Douglas and Zawadi Nikuze

Summary

The Story You Need to Hear

Learning From Within

The Worst Place to Be a Woman

Conclusion

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 Plan

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 sustainable peace.

This approach has four main tenets: community, comprehensive healthcare, trauma, and women.

Community
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 cost.

Recognizing that 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.

Trauma
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 Hear”.

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.

Women
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, and medicines.”

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.

Together, these 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.

Next article:FWA’s Philosophy