Burundi: Providing care to those with none

A national survey conducted by MSF during the final quarter of 2003 suggested that approximately one million of the country's six million inhabitants had no means to attain health care and three million had to use extreme measures to gain even limited access. Teams treat patients in clinics and hospitals in parts of the country where war and displacement have left civilians without health care or with little access to it. In the capital, Bujumbura, MSF treats war wounds, manages a health center and runs a medical/surgical program in a local hospital. In 2003, MSF opened a new center in Bujumbura to assist survivors of sexual violence. The country's civil war and resulting economic crisis have left civilians with little access to care. MSF is concerned that a new cost-recovery policy, implemented nationwide, will further reduce people's ability to get needed care (see page 12). A national survey conducted by MSF during the final quarter of 2003 suggested that approximately one million of the country's six million inhabitants had no means to attain health care and three million had to use extreme measures to gain even limited access. MSF overcame significant barriers to open a sexual violence project in Bujumbura - a city where the term "rape" does not exist in the local language. Now the clinic, opened in September 2003, sees 120-150 new cases each month. Housed in a downtown shopping area, the clinic treats gynecological wounds and helps patients to prevent being infected by HIV or other sexually transmitted infections as well as to avoid unwanted pregnancies. MSF also provides counseling services to give survivors a safe environment in which to talk about their experiences and learn how to cope with them. In addition, MSF operates nutrition programs, prepares to respond to epidemics and treats people with infectious diseases. In Bujumbura Rural province, MSF provides basic medical care in the district of Rwibaga where the most common illnesses treated are respiratory infections, diarrheal diseases and malaria. Special attention and support is given to the Karinzi health center, which assists an estimated 50,000 people living in an insecure area. MSF supports various health care structures by providing training, medical assistance, supervision and supplies. Since the beginning of 2004, emphasis has been placed on maternal health. A mobile MSF clinic at a camp for internally displaced persons in Kivoga provides first- and second-level medical care to approximately 10,000 people. MSF has also launched several cholera interventions, most recently in March 2004 in the district of Rubiza. In response to a number of malaria epidemics, MSF has launched a large-scale emergency program that offers both curative and preventive care. In 2003, the team helped change the national malaria protocol to implement the use of artemisinin-based combination therapy (ACT). MSF now supports training of medical personnel and supervises implementation of the new protocol. In June 2004, MSF began to assist thousands of people who had gathered at Burundi's border in their attempt to flee fighting in the eastern region of the Democratic Republic of the Congo. MSF teams set up two mobile clinics and opened a cholera treatment center in Cibitoke Hospital and isolation areas in two displaced persons camps. Later in August, about 150 people were killed and 105 wounded when a refugee camp in Gatumba, on the border between the two countries, was attacked by a military group who set fire to buildings where the refugees were sleeping, and used guns, machetes and hand grenades to kill others. Victims were brought to the nearby capital, where MSF treated more than 20 of the wounded and operated on eight. MSF also provided victims with psychological support at its center for the war wounded and at its health center for women in Bujumbura. MSF has worked in Burundi since 1992. INTERNATIONAL STAFF: 83 NATIONAL STAFF: 842