A health clinic where thousands of Rwandans seek refugee in Burundi

Refugee camp and health

Setting up a clinic in a camp for refugees and displaced people requires a specific approach. Refugees are more vulnerable to diseases due to circumstances surrounding their flight and their living conditions. Inadequate shelter and overcrowding contribute to the transmission of infectious diseases, such as measles, meningitis and cholera.

Vaccination campaigns against such killer diseases as measles are always a high priority and are repeated as the camp population grows. Aside from the fear of epidemics, many refugees suffer from respiratory tract infections, malaria and diarrhoeal diseases. Children, women, the elderly and the disabled are the most affected groups.

The refugees' well-being, and sometimes their very survival, depend on four key factors: water and sanitation, food, shelter and health care. As people's living conditions have a great influence on their health, MSF staff working in a refugee camp typically monitor all four of these elements.

They must determine: How can the refugees get water and how much water can they obtain? How clean is it? When were food, soap or blankets distributed? If not, why not? How much was given to each person? Are fresh fruit and vegetables available? How much do they cost? What is the state of the shelters in which people are living? Do they protect the refugees against the cold, humidity, or rain? How many latrines are there? Are people using them?

In January 2006, MSF set up a health clinic in the Musasa refugee camp in northern Burundi. MSF saw the need to build the clinic when thousands of Rwandans fled from their country and entered Burundi, the majority of them gathering in this camp. Each month, the MSF team treats around 11,000 patients at this clinic.

A health clinic in a refugee camp setting has to meet special needs.

"The big difference with a regular clinic is that you have to start from scratch: poles, sheeting, what are the specific needs of the population. What illnesses can you expect? What medication will they need?" said Ineke Swaans, MSF's Project Coordinator in Burundi, originally a nurse from The Netherlands, who has worked in MSF projects in Democratic Republic of Congo (DRC) and another project in Burundi.

"The needs of those living in a refugee camp are so clear: People are living in a fixed, contained area. They're new here. There are no structures or systems in place. Our work here is a pure case of providing access to health care: If we weren't here, they would not be able to get any medical assistance at all. They cannot go to a regular clinic because they have no citizenship here."

Assemble a team

Once MSF made the decision to intervene in the camp, it had to put together a trained medical team for the clinic, bearing in mind that the majority of the Rwandans who fled their country only speak Kinyarwanda, a language similar to Burundi's tongue, Kirundi.

A group of Burundian nurses was recruited from MSF's other project locations in the country and a doctor was found in national staff member Guy Simo Ndounoue, originally from Cameroon but trained in Burundi. Community health workers were recruited from among the camp inhabitants. Their job is to gather information on the health situation and actively look for people in the camp in need of medical aid. At the head of the medical team is Carole Mulachie, a French nurse.

Seeing all patients

To ensure that the clinic works efficiently, Carole and Ineke designed a special layout to enable patients to move easily to the right area of the clinic. "We've designed the layout of the clinic to optimise the patient flow so we can help all patients on the same day.

Every morning, the waiting room is full of people. On an average day, we see about 350 patients, on Saturdays that can go up to as many as 600. We don't only treat Rwandans here, we also care for Burundians who live in the area. When we started here, we told the authorities that the Burundians were welcome in our clinic. The next day, they started coming in," explains Carole.

First triage

First, all incoming patients undergo triage, an initial screening that helps the medical staff determine which patients need help first. People who urgently need care are given the first consultations. Once the consultation is done, those needing medicine are sent to the clinic's pharmacy.

In the large, main waiting room, nurses divide the the children and adults. All children are checked for fever and sent to an adjacent area. Children with fever go to the left side of the room to receive paracetamol and a malaria test that delivers results within 15 minutes. Children suspected of being malnourished, are sent to the right side of the room to be weighed.

Wounds and dressings

Those who have wounds wait outside of a special wound dressing area where two nurses attend to wounds all day long. Many people have open wounds that started as itchy skin conditions&#—related to poor living conditions. When people scratch these itchy patches, they can bleed and become infected. Homemade bandages made from pieces of cloth often make things worse. Others have specific medical problems that require regular dressing changes.

Patients that need to be monitored for a few days can stay at the clinic for a few nights. People needing more advanced care, are transferred to a nearby hospital.

Second and third round

In this way, people move around the clinic and new people arrive and take their places in the waiting room. Various rounds of triage are done throughout the day to ensure that the sickest patients receive the fastest care. By the end of the day, all of the patients will have been treated.

Life continues

"The days are too short here," Carole sighs. "Illnesses, wounds, transfers, deaths and births, it all takes place right here." In the end, a refugee camp is a world onto itself where life continues despite everything. Each day two to three women bring new life into the world, delivering babies at the clinic. The delivery room is clearly the team's favourite stop during the day, bringing joy and a smile to each face.