On January 19, 2005, I visited the Kamenge aids clinic in Bujumbura, Burundi. The program is run by Friends Women’s Association of Burundi, and supported by Friends Peace Teams. I was there with Elie Nahimana, General Secretary of Burundi Yearly Meeting, and Adrien Niyongabo, coordinator of Healing and Rebuilding Our Communities program. I visited for only five hours.
Cassilde Ntamamiro, coordinator of Friends Women’s Association in Burundi, was our host on this day, which was set aside for the clinic’s monthly communal meal. Cassilde says she would like to do this once per week if the funds were available. The clinic has about 70 people who are hiv positive registered in their program. And according to their meticulous records, five of these have already died. Approximately 30 of the hiv-positive clients attended the gathering—most were young women, four with small children; five were men, four of whom were older than 40. When we arrived, the women were preparing a substantial meal. Cassilde showed us around the clinic—the large waiting room, the consultation room, the small shop for selling items to the public, the haircutting business on the side, and the store and medicine rooms. She also showed me three rooms that were unfinished. In one of these rooms was a bed for patients who needed extra care.
As people were gathering, the first activity was a public meeting that was part educational, part organizational, and part advisory. One topic was about the importance of good nutrition. Questions about vitamin pills came up and various varieties (including the one for children) were displayed to the clients. There was also discussion on a better method to notify all of the clients—who come from a rather large catchment area of Bujumbura—about the clinic’s gatherings. Almost half did not attend, but if they had I don’t know where they would have fit, as the room was filled almost to capacity. There was also discussion of electing a committee for the group. Those present decided to postpone this until everyone could be informed.
Those who are able are asked to pay 200 francs (less than 20 U.S. cents) per month to the association. These funds are used for hospital trips and funeral costs. Cassilde wanted them to "buy in" to their organization so that it didn’t seem like complete charity. As to advice, one man said that he was afraid to go upcountry to tell his wife that he was hiv positive. So the group counseled him to bring his wife to Bujumbura where he would tell her. She would be tested at the clinic, and advised according to her test results. I don’t know if this happened, but the meeting demonstrated the variety of help that such a clinic provides.
The most shocking thing for me was the story of one of the women clients who had brought her husband to the clinic. His first wife had died of aids, his second wife had died of aids, his third wife had died of aids, and now his fourth wife was hiv positive. From other data I had received it seemed that men lived much longer than women when they became hiv positive. Cassilde explained that the reason for this is that the men had more access to meat, milk, and medicine. With the better nutrition, they lived longer.
Denial of aids runs very deep in Burundian society. A student at Great Lakes School of Theology, named Fidele, had died a few days before. Cassilde knew he had died of aids; but the student did not admit it and had postponed testing until it was clearly too late. The previous year his wife, Bernadine, who was also a student at the school, had died of aids. Burundi Yearly Meeting has a little over 15,000 adult members. Probably 1,500 to 2,000 of them are hiv positive. Cassilde lamented the fact there was not one person willing to publicly stand up in church and tell people that she/he was hiv positive.
The clinic also sees regular patients who are sick with malaria, intestinal problems, and other illnesses. Its log at the time showed that they had received about 1,500 visits in less than a year and a half. While we were there about ten people came with these types of conditions. They meet with the nurse who prescribes appropriate medicines as necessary.
It was moving to be in a room full of people who are destined for an early death—many very young, including teenagers. I had read that hiv-positive people in Africa die much more quickly than those in the United States, for example, and it became clear to me that the reason for this was lack of proper care and nutrition. Living hiv positive, if one follows healthy living habits, one can continue with a normal life for many years. With neglect, poor nutrition, and poor living habits, however, an hiv-positive person dies quickly. The kind of work that this clinic is doing is important because it offers the resources and support that hiv-positive people living in this part of the world are not otherwise able to get.
Cassilde asked me if I would stay for lunch with the clients. She seemed delighted when I answered yes. Everyone was served mounds of rice, beans, greens, and a piece of meat. While we at the head table were given our own plates of food, the clients sat in groups of five or six and were served large platters. Each was then given a kilogram of rice and a half kilogram of beans to take home.
Later, Elie, Adrien, and I went upcountry to Gitega. There, a woman named Felicite Niyonzima told Elie that she was hiv positive and willing to speak publicly about it. When we asked if we could take her picture, she declined. Later we met, and her story spilled out—as tends to happen the first few times those who have had a traumatic experience tell their story. She was married with two children and her husband died of aids in 1998. It took her a year to be tested, which was when she found out that she was hiv positive. She is the assistant to the Gitega provincial educational inspector. She had quietly told her family and her employer. Clearly she had the means to continue with healthy living and so, although seven years had gone by, her viral load level was still too low to require medicines. When I asked her what she expected would happen when she spoke out publicly in the church, she replied that she expected many people who were hiv positive to come to her for advice and support. I suspected that she would quickly be overwhelmed by the number of people approaching her. Elie immediately invited her to speak at the next Burundi Yearly Meeting pastors’ meeting in April. When we finished, she agreed to have her picture taken with us. A meeting was to be arranged quickly between Felicite, Cassilde, and the person responsible for aids awareness in the yearly meeting, to discuss how to support and help Felicite in her witness.
Two days later, as we drove back into Bujumbura from Gitega, we saw two pickup trucks full of people. The first one was carrying a decorated cross in front. Elie honked and waved to the people in the trucks—it was the funeral for the Great Lakes School of Theology student who had just died of aids. Later in the day, when we were leaving the church compound in Bujumbura, Adrien pointed out seven children, dressed in their Sunday best, walking down the street. Their ages were approximately 5 to 17. They were the orphans of the two students who had died.