Burundi is nearly the poorest country on earth. Ravaged and traumatized by civil war for nearly a decade, the nation hovers near the bottom of the world’s human development rankings.
About 80% of people live on less than $2 a day. And 200 doctors care for a population of 8.5 million.
Deogratias Niyizonkiza “Deo” counted those doctors himself as he surveyed the hospitals in his home country in East Africa, just south of Rwanda and east of the Congo.
Deo spoke in Boston Sunday to raise awareness and funding for the organization he began in 2005 called Village Health Works. Deo spent a lot of time describing the miserable conditions of the people in Burundi. He showed pictures of the shacks people call home, their contaminated drinking water and their impassable roads. He showed pictures of a child with swollen spleen due to repeated malaria infections and of another child abandoned like an animal by his family.
“When there is pain there is no joy,” Deo said. “A lot of tragedies have to do with misery. When people are miserable, they do desperate things.”
Deo led the creation of a clinic in Kigutu, Burundi built with the local community’s volunteer labor and donations from abroad. In its first fully operational year, the Village Health Works clinic saw 28,000 patients. Clearly health care was needed, but Deo emphasized that it was just one of the many needs requiring attention to relieve the misery and suffering in that community. In Deo’s eyes, the clinic was more than a place to bandage wounds and deliver babies. The clinic became a source of community pride and a place of reconciliation to bring peace.
Deo is the protagonist of Tracy Kidder’s book The Strength in What Remains. Kidder also wrote the book Mountains Beyond Mountains that helped make Paul Farmer and Partners in Health famous. In this interview, Kidder explains why he wrote Deo’s story.
I spend most of my time lately thinking about the strategies and management practices necessary to sustain large-scale public health programs. In the research project I’m working on, we are trying to extract best practices for doing so by examining large-scale HIV prevention programs. Increasingly, global health practitioners are recognizing that making a lasting impact demands that organizations operate at sufficient scale to take advantage of the efficiencies and political clout that tend to accompany larger size.
Hearing Deo’s story Sunday reminded me that securing community buy-in and being relevant to the local culture and needs also are critical to success and sustainability. How do large-scale programs balance centralized, national services with the need to tailor programs and services to diverse community needs to maintain community involvement? It is not easy, which is probably why there are so few examples of organizations doing it well.
Deo did not hold back when telling the audience what is not needed. “Too many people are trying to solve Africa’s problems from conference rooms in Geneva and Washington when they don’t really know what people need,” he said. “They have no problem spending thousands of dollars to fly one person business class, but they don’t sit down and ask people their needs or empower them to solve their own problems.”