White Coats, Dark Times

It’s December 11, 2015 early at 7AM. I am in Kigali (Rwanda) and open my eyes to the gentle noise of birds chirping close to my bedroom window. At this moment, I am unaware that across the border, my friends and family had been woken up earlier by the loud noises of gunshots and grenades reverberating across Bujumbura (Burundi, my native country). For them, a new day started with overwhelming fear hovering across the city like dark and threatening clouds before a daunting thunderstorm. Another day that brought a climate of terror and chaos in a country already deeply embedded in a political crisis which started in April 2015 after President Pierre Nkurunziza’s contested bid for a third term.

Among the many Burundians affected by the intensified and recurrent conflicts in our capital city are my close friends Elsa Ngendakumana, Aristide Mbonihankuye, and Landry Muhizi — three rising leaders who are greatly appreciated for their charisma, humour, kindness and, more importantly, their bright minds. All three are young and talented medical professionals. During this time of turmoil, they have to face unprecedented challenges and yet, amidst all their daily hardships, they remain dedicated to the fight of health equity and social justice.

As frontline health workers in a war-torn country, I believe it is important that their voices be heard.

How has Burundi’s current situation affected your line of work?

Dr. Aristide Mbonihankuye: I work as a general physician at Kira Hospital, a new and private hospital that opened its doors a few months before the crisis escalated. Kira Hospital was built with the objective of providing specialty and high quality medical care to both Burundian and other eastern African patients. In addition, the hospital aims to give patients medical services that were not previously offered in Burundi, ultimately reducing the number of people who travel outside of the country for treatments.

Unfortunately, the current situation has complicated our hospital operations on many fronts. First, some of our qualified staff have fled the country because of the insecurity. I am now often confronted with helping patients who require specialized skills which are beyond my qualifications and there is a lack of medical staff to refer them to. The hospital responded to this problem by creating a new consultation schedule to maximize the time when our specialty team is available.

Second, another big impact on the hospital work has been the procurement of equipment, drugs and other biomedical supplies, which is becoming more difficult.

Finally, while a few months ago the hospital was visited by more people, currently the number of patients coming from neighboring countries has significantly decreased due to the safety issues that remain worrisome. Now we do our best to reduce the time our foreign patients spend at the hospital in order to minimize their stay in Bujumbura.

Dr. Elsa Ngendakumana: I am the Medical Advisor for a private construction company called Sogea Satom Burundi. One of my responsibilities is to follow-up with employees after work-related accidents occur and ensure they are receiving proper care. I am in charge of referring them to accredited hospitals, helping them navigating health insurance issues, supporting them in getting their prescription drugs and medical exams completed.

My work has been challenged by our current political crisis in many ways. For example, one of the accredited hospitals in an area where our construction workers are located had to close and another hospital was attacked. A pharmacy in another region has gone bankrupt, many specialists working in these hospitals have fled the country, and the roads leading to hospitals are not always safe. Therefore, referring employees to different hospitals is now more difficult as I have to take into account many other factors such as accessibility based on road security. The nearest hospital might not be an accredited one and even if it is, it might now lack human resources and other necessities. Sadly, if there are any night emergencies these days, I might not be able to help because of heavy gunshots and barricaded roads.

Dr. Landry Muhizi: As head of the Medical Program for a non-profit organization called LifeNet, I coordinate all the activities related to clinical training with doctors and nurses. I also actively participate in the design of training materials for our local health partners. Another aspect of my job includes monitoring and evaluating our training sessions to assess if they lead any changes in terms of sustainability and quality of care. Because of the current situation in Burundi, LifeNet trainings for community health centers stopped for a long period of time. And even after activities resumed, we had to deal with many challenges such as financial, which directly affected our ability to train and disseminate knowledge that could greatly contribute to improving health care services.

How can doctors continue to promote the values of leadership, social justice and hope in critical times?

Dr. EN: Doctors should focus on providing patients-centered care. It is important they spend more time listening to their patients. Now it seems that a simple check-up visit is taking more time as many patients are also seeking comfort in dealing with their daily stress as well as health issues. We have to stay aware of our patients’ needs which have been aggravated by the crisis.

Also, doctors should demand that hospitals remain safe places and accessible despite the roads not always being secure and/or local violence.

Last but not least, doctors should not take part in political debates and more importantly they should treat their patients equally to ensure no distinction is made between patients according to their political affiliations.

Dr. LM: All doctors have consciously taken an oath binding them to put forth patients’ interest under any circumstances. Based on this commitment, we are called to promote the values of hope and tolerance by continuing to provide quality care without discrimination and, even if it can be hard, by not letting ourselves become overwhelmed by this political crisis.

Dr. AM: The ethics of our medical profession require quality care for all patients. By continuing to treat patients without discrimination, doctors will help people retain confidence in the health care system which should remain equitable and fair to everyone. By doing their best to ensure quality care and only solve the problems impeding them to treat patients properly, physicians will be able to overcome this difficult time as best they can.

From drug procurement issues to the scarcity of resources and financial constraints, my friends’ experiences only highlight a few of the barriers Burundian healthcare workers are called to overcome these days. Yet, they go to work and perform their duties in spite of the insecurity, fear and violence that is clearly palpable in our capital.

Yes, it is extremely difficult to work in these conditions.

But if Aristide, Elsa and Landry can find strength to promote health equity in a conflict-affected and fragile country such as Burundi, then we are all called upon to not be paralyzed by fear during these extremely challenging times for global health professionals all around the world.

For the year ahead, let’s then be inspired by my friends’ words and share with our world the gifts of compassion and inspirational leadership while we continue to fight the good fight with resiliency.

Francine Irakoze is a 2015–2016 Global Health Corps fellow at Health Builders in Rwanda. All GHC fellows, partners and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. Join the movement today.