There is misery here.. And singing. Usually singing alongside the misery.

Jos is 33 and looks like 65. 60 pounds. She has been hospitalized here since February 8th. Her daughter is only 8 and sleeps next to her mom who wastes away slowly. What will she do when she finally disappears? For now she sings, and dances and laughs all around the compound. And poses for pictures as she sings the Burundian national anthem.

The Burundians have lived through so much. It is really hard to imagine. And I am outside of it, so far from it. Thankfully.  But physically being here, there are a lot of refugees making their way back to Burundi from Tanzania. At this clinic, on top of this hill, every day about 80 people line up to be seen. There are 12 in patients. One is Joselyn. She has inguinal lymph nodes the size of golf balls. She has lost 20 pounds since she got here and we are trying to figure out what she has. It’s either Tuberculosis or cancer. We hope its tuberculosis because then there is hope there. That we can treat. Cancer, she will die. If its cancer, I am encouraged by the fact that she would die even in the United States with this degree of cancer. That is not true for so many of them. Dumb diseases. Easily treatable diseases. Its like trying to open a door and all you have a paperclip. But the paper clip has fallen on the floor in a large room that is pitch dark. And even if you find the paper clip you won’t necessarily be able to open the door. Even if you figure out the disease, doesn’t mean you will be able to treat it. But you know there are keys that can open the door. There are a million of them, but they cost money that you don’t have. So you just piecemeal with what you have. And doctors and nurses all around the world have been doing it for decades. Every time I think what I would do in the states and then again, what I would do here in Burundi. I always ask the Burundian doctor alongside me if we have such and such medicine. And he always smiles and says “no, we are poor”.

By Dr Sriram Shamasunder

Photo courtesy Matthew Lester Photography

This Post Has One Comment

  1. Some of these entries from when I was in Burundi around 4-5 years ago, and reading them now I feel a distance from. They are true to my experience then, no doubt I remember the visceral response of being just out of residency and trying to understand so much suffering, and preventable suffering. I think on some level coming out of residency I just wanted to serve, I wanted to make use of my skills, go where there was need. I thought that the talent of an American physician might make a world of difference. And maybe it did, to some extent. But the experience also made me realize that we need delivery systems to do this work, we need real solidarity with the public health systems of these countries, and we need real solidarity with the health professionals that have been working in these systems for so long. So these entries still have a flavor of “mission work” to me. And in mission work, I think you can have right intentions but not go at the issues strategically or in a way that can 1) build for the long term, in terms of improving the capacity of the country, improving the delivery systems, and 2) address the burden of disease in a systematic way- what people are suffering from in real time and not just what you might be good at and 3) address the social determinants of health in a way that can only be done meaningfully if you are working with people that really are part of the community and are participants in determining their own lives and health. — Sri

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