I met two young girls in Burundi this week whose personal health crises lie at the core of the challenges International Medical Corps is facing in a country that is tiny in size, densely populated, and among the 10 poorest in the world.
One of these girls was at the beginning of her crisis; the other in recovery.
I first met “Jacqueline” inside her family’s small brick hut in eastern Burundi, where she was lying in her bed, a blanket pulled tightly over her head. When she was not wailing with pain she was hyperventilating from fear. She was frantic and inconsolable.
A week earlier, while visiting her sister, Jacqueline was raped by her sister’s husband.
In Burundi, the rate of violence against women and young girls is high – a result of decades of conflict that ended in an initial peace agreement in 2003. What’s more, perpetrators regularly escape prosecution and punishment.
Immediately following the incident, Jacqueline went into hiding near her sister’s home and her family could not find her for two days – a critical time period in the treatment of victims of sexual violence.
When Jacqueline finally was found and brought to the hospital IMC counselors were called in to assist. The counselors tell me the first time they met with Jacqueline she repeatedly broke down while trying to recount the ordeal. “As she tried to tell us what happened she was re-living it over and over again. She was terrified,” one of them explains to me.
Once Jacqueline returned home, outreach counselors continued to visit her - hiking down a steep hill, thick with banana trees and cassava bushes, to reach her house. Despite her horrific experience, Jacqueline is fortunate to be surrounded by her family and numerous neighbors who paid visits to check on her and lend their support. Frequently in such situations, victims are stigmatized and rarely seek or get the physical and emotional support they require.
IMC is providing Jacqueline and other survivors of sexual and gender-based violence with medical care, counseling and socio-economic support, as well as referrals for those who need additional assistance so that they are getting comprehensive care.
It is impossible to know how Jacqueline will fare. The pain and the memory are still too raw; her recovery, if you can call it that, has only just begun.
Then, there is the case of five-year-old Mary, a shy, beautiful child who was brought into IMC's Outpatient Treatment Program site by her grandmother, Esperanza. At this nutrition center in Bunyari, a village in the very northern part of Burundi and one of 37 centers IMC is supporting in the country, we are monitoring children and providing them with supplemental food, like Plumpy'nut, Corn Soy Blend, vegetable oil and bulgur. According to the World Food Program, 57 percent of children under age five in Burundi suffer from chronic malnutrition.
Esperanza tells me through a translator that Mary’s mother and father separated last year. The father married another woman and he no longer cares for Mary and her four siblings. Mary's mother also left and went to Tanzania, so the grandmother now cares for all of the children herself.
Mary quickly slid into severe malnutrition. By the time she arrived at the stabilization center she weighed about 20 pounds; the normal weight for a girl of her size and age should be closer to 40.
Today, after carefully calibrated therapeutic feedings, Mary is recovered and able to stay at home. She still must regularly come to the OTP for monitoring, where she is weighed and measured and where IMC provides food for the week - on this particular day that meant 25 packets of Plumpy'nut and 2.3 kilos of bulgur. IMC also educates Esperanza and the other parents about maintaining proper nutrition for their children and recognizing the early signs that something’s wrong.
IMC has just launched a multi-year program across Burundi to identify and manage acute malnutrition through the community and the local health ministry, as well as work toward changing behaviors so that we can get real traction in reversing chronic malnutrition.
Esperanza laments how difficult it is caring for all of her grandchildren and struggling to make sure they have enough to eat. But when I ask if IMC has gotten Mary the care she needs, Esperanza nods her head vigorously, takes both my hands and says over and over in the local language of Kirundi, “murakoze,” which is simply “thank you.”