Burundi Realities

Burundi Realities ---

Yesterday while teaching my students about tuberculosis, I learned several things about Burundi realities. First of all, they knew very little about tuberculosis.  They knew that it made people cough, but not much more than that.  As we began talking about tuberculosis and what causes it, how to treat it and how to prevent it; I learned some things about this country that are incredibly sad.  Things we probably all know, and have heard before, but if you are like me, you just say, “Oh, yeah, that is too bad, and go on about your day.”  

Tuberculosis (TB) is transferred from person to person through the air, from things like coughing or sneezing.  In the U.S., if someone is in the hospital with TB they are automatically put in a special room.  The room has a double door system and negative air pressure so that the air in the room with the patient is never circulated though the rest of the hospital.  Anyone going into a patient room of someone who has TB or is suspected of having TB must wear a mask and gloves and a gown to make sure that they do not inhale any droplets that may contain the disease.   This is one of the ways we keep people safe and help stop the transmission of TB. 

Here in Burundi, I learned that nurses are forbidden to wear masks!  I realize that they do not have the money to have the fancy negative pressure rooms that we have, but something as simple as wearing a mask…and it is forbidden!  I felt so sad for this class of 70 future nurses, knowing that when they come into contact with a person who has TB, there is little they can do to protect themselves.     The students told me, here for a nurse to wear a mask is forbidden because it is considered to be rude.  Rude because you would be portraying that there is something wrong with the patient, and it would make the patient uncomfortable.  How does one change the culture of an entire country to allow nurses and doctors to wear masks when caring for patients?

Being malnourished is a huge risk factor for contracting TB, especially in children.  We were discussing this is class and talking about how do we keep children in better health so they are less likely to get diseases like TB.  The students said, well, if the family has no money for food, then there is nothing we can do.   Sad, and in some cases true!  However, I happen to know that in several areas in this small country there are feeding programs set up for children by different organizations…I know the group I am here working with has one, and world vision has one, as does world relief, and many others. 

The sad part to me was, these students had NEVER heard of such a thing!  Never!  I had to explain to them what a feeding program was, and tell them where the ones were that I knew about.  So, if the people that are educated and going to be the future of the health of this country, don’t even know about these programs, that is a huge problem.  How can they tell the parents of the starving children they are caring for where to find nutritious food for free, if they have never been told about it?

These students had never been told about the teaching role that a nurse plays.  Here in Burundi, I see their role as mostly teaching and educating.  After we talked about tuberculosis I put some numbers on the board showing them how if each of them taught 5 people in their community about tuberculosis;  how to prevent it, what symptoms to look for so you can go to the hospital, and how it is treated..How many people that would impact.  Then if each of those 5 people told 5 people and so on…eventually their knowledge could reach thousands of people.  Just like TB is killing hundreds of thousands of people here every year.  I told them, this is how you change the health of your country.  You change the health of each of your communities, by teaching them how to stay healthy and when to seek care.   I had them work in groups to come up with a plan of how they would teach people in their community about tuberculosis.  Once they understood what I was talking about, and how important it was, they took the assignment very seriously!  I wish you all could have seen the light bulbs turn on over their heads when they realized that they could in fact help save their country.  What a great feeling…we are doing a great thing here!  I say we…. because I would not be able to be here doing this if it weren’t for all of you, and to that I am forever grateful!

I have seen that many people look at these students, and at many of the people in the country as lower class citizens, and do not treat them as intellectual equals.  I am here to tell you, that these students are very bright!  All of them know 3 languages, and many of them know more.  They are learning how to be a nurse in a language that many of them just started to learn 2 years ago.  I barely survived nursing school in my own language; there is no way I could do it in a foreign language!  These students are here because they want to change the health of their country and they want to save and change lives.  When you ask nursing students at a university in the U.S.; why do you want to be a nurse?, you get many canned answers like, “because I love people,”  and others will say, “because it pays well, and I will always have a job.”   Many students in the U.S.  have deeper reasons why they want to be a nurse as well, but the motivation is rarely at the level of what I am about to share with you from the students here.  When I asked my students here to write down why they wanted to be a nurse, the answers were painfully different!  Here are some direct quotes, broken English and all:

 “because in 2009, a nurse save my life.  I saw that the best place to save someone is to be a nurse and I decide to come to study in the nursing department.”

“because I want to treat the patients and help those who are suffering by whatever diseases.  And more than, I love so much to rescue someone who is miserable in his daily life.”

“because I need to protect the patient by the death.”

“because health and living conditions in my country is poor.  I choose to be nurse to improve health in my country.”

“because conditions of life here are bad, people need help in health promotion.  That is why I choose to be their promoter and helper.”

I am a cow...and it was meant in a nice way??

A some of the students working on a group assignment.

Another group of students.   I had to split the students into 3 rooms for the group assignment so they would have enough room.  Both groups above are working on writing out a plan for what they will teach the people in their community about tuberculosis.  Once they understood what I wanted them to do, they did a great job!

 

Yesterday I was called a cow ----

Yesterday I was visiting with one of local teachers at the University.  He mentioned that he had recently returned from Korea where he obtained his masters degree.  Knowing that he also spoke French and Kirundi, the local languages here, and was talking to me in English, I asked him how many languages he spoke.  He responded with 5,  I laughed and said, “oh, I only speak one.” He then laughed and said, “oh, you are a cow.”  The other person in the room and I both stopped for a minute, not sure whether to laugh or what.  Then he continued on, “we call people that only speak one language a cow, because cow’s can only say, ‘moo, moo’.”  He continued on to say, that this was not an insult, and in fact, cows are very highly thought of here.   Later while visiting with some of the other missionaries on campus, we all had a good laugh about the fact that I am a cow!   I am trying to not be a cow.  I have learned a few words in French, Kirundi and Swahili! 

The mosquitoes here are huge and there are so many of them!  If I go outside at night for even just 5 minutes, I am sure to get 5 bites.  It gets dark here very early, I get out of class at 530pm, and I have less than an hour of daylight before I need to be shut inside away from the mosquitoes!  I am so thankful to have the mosquito net to sleep under at night!  There was one hanging here, when I got here, but it sure felt great to put up the new one I brought with me, knowing it was fresh and clean! (Thanks Nicole!!)

My class is continuing to go well.  I think they understand more of what I am saying, and they are getting used to my teaching style.  They are not used to doing group work, and every time they get in a group to do something they assume they are going to get points for it.  They are very driven my points here.  They operate under the Belgian system of schooling, which is very strict…they take attendance at every class, and if you are absent for more than 25% of the classes, then you fail the course.  There is a lot of fear in the students about failing.  You can tell that their experiences with teachers who work with them to succeed has been limited.  I am enjoying working with them and learning along side of them.    Many of the students have very good questions, and we are learning together how to adapt some of the things that would be common in the U.S., to what they have available here.   I was teaching yesterday about patients with respiratory problems, and when we were talking about patients who have a hard time breathing if they lie flat on their backs, I said it would be important to make sure they can sit up some in bed.  One student asked, how will we do that?  So, we talked together about what they could do…and came up with asking the family to bring pillows or blankets from home to put underneath the mattress to raise it up some.  Here in Burundi, as with many of the countries here, the family must provide these types of things for the patients; pillows, blankets, and they also must feed the patient, and take care of most of their daily needs.  I explained to them that in the U.S.  our beds are electric and we can lift them up to the height we need.  This made them all laugh, and they asked if people had beds like that even in their homes!   The students have been a lot of fun to work with, and I am really enjoying being a part of their education journey.

Next week I will be going to the upcountry for a week, to the Kibuye hospital.  I am really looking forward to getting out of the city.  In the city, I am stuck on campus most of the time, because it is not safe to just go wander around by yourself.  The campus is not that big, so I am looking forward to having some more space to be in and see a different part of the country.  I think it is a several hour car ride on very poor bump roads.

Amahoro

Amahoro means peace, in Kirundi.  Kirundi is the most common language spoken here in Burundi, and I am finding it easier to pick up on than French.   When you are shopping in town, many of the people there speak Swahili, and that too is much easier than French.  Turns out watching the Lion King several times is coming in handy! J  Many of the phrases used in the Lion King that are Swahili have been useful since I have been here.  I am already starting to talk in very articulated and short and simple English, so that the students can understand me…so please forgive any weird sentences, it is hard to switch out of that.

Things here are going well.  I am looking forward to getting going on teaching, I had my second class this afternoon, and it went great!  At least it seemed like it went well, I don’t know if the students would report the same, but I hope that they would.  The class started slow, as it took about a half an hour for them to find the projector so the students could see my PowerPoint.  Then after a couple hours of class, someone came and took the projector from us, to use in one of the medical classes.  So, I resorted to writing things on my stick on the wall -- white board paper that I brought with me. 

We went over physical assessment today, they have had the information before, and so it was a bit of a review.  I can tell that some of the students are very sharp and understand English very well, while others are struggling.   Here in Burundi, there is a belief of “no one left behind,”  so when one student doesn’t understand something, the ones that do, will help explain it to them.  I am told that this is a good concept in theory, but it becomes a problem during exams, because they want to do the same thing at that time and share answers.  I really enjoyed the class today.  It is so fun to see the light turn on in them when they get what I am saying.  There reaction is so much different from the students I have taught in the U.S.   The students here, are desperately trying to understand a concept and when they finally understand it and can articulate it back, they grin from ear to ear!   It is such a pleasure to be a part of their learning.  Not to say that the students I have taught in the U.S.  are not fun to teach, they are, this is just fun in a different way!  When I was showing them where to check a brachial pulse, they all started laughing.  Apparently the way I was showing them looked like I was flexing my bicep for them.  I am glad that they can laugh and have fun, while still learning.  

I found some stethoscopes on campus that are waiting to be taken up to the upcountry hospital at Kibuye, so I took them to class today.  You could tell that many of the students had never used one before, there was a lot of giggling and “ah now I get it” looks on their faces as they were listening to each other’s heart, lung and bowel sounds.    I had some students run in place and jump up and down and then have their classmates listen to their heart so they could hear the difference in the rate.  This brought on many giggles and laughs, but I could tell they were enjoying it.   I am glad to be doing what I came here to do!  I have enjoyed the week exploring, but this is really what I love doing, and I feel so blessed to be able to be a part of their education.   Not only am I a part of it, but all of you at home that have been supporting me emotionally, spiritually and financially to make this possible, are all a part of the education of these students.  We are doing a good thing here!

 After the first blog I did, about the students not having any stethoscopes, my dad sent me a link to an organization called worldscopes that donates stethoscopes around the world.  I emailed them, and they are donating 50 stethoscopes to Hope Africa University!  Thanks for the link dad!  The students will be so excited, the only bad part is, I will probably not be here any longer when they arrive, but I hope to be so I can see how excited they get J

I took a bus ride into town the other day (sorry mom!).  I promised my mom I would not ride any buses here, because she is afraid of what will happen on them.  I was safe about it, and went with another missionary and also one of the medical students.  It was a good experience to have, but I am probably good if I don’t do it againJ.  We also went to the local market where everyone shops so I could see what it is like.  It is a huge building with no roof, and hundreds of booths are crammed inside.  It is organized by type of shopping…like men’s clothing, women’s clothing, food, office products, etc.  Many of the items here are used, and they are reselling them.  I was told that there are many labels found here with goodwill or value village on them.  This is a market where you bargain for the price, and if you are white they automatically start with a price twice as high as they would for a local.  All of the people here, when I pass by, or any other white person passes by they say, “umuzungu” which is Kirundi for white person.  They will walk right up to you and say it and point.  At first I thought they were saying it in a negative way, but I have been assured that it is not intended in a negative way.  The way it was explained to me, was it would be similar to seeing a celebrity walking through your neighborhood.  If you saw that, you might point and shout their name.  Everyone wants to shake your hand or touch you.  One woman wanted me to touch her child that was strapped to her back.  I touched the baby’s cheek and got it to smile for a few seconds.  I was later told that this is equivalent to a blessing and that this mom will be telling all of her friends that her baby was blessed by a umuzungu. 

Driving here is kind of scary.  There are no rules to the road, except for on the street the president lives on.  On that street everyone must stop at any street that intersects the street the one that goes to the presidents house, even if no cars are coming.  As far as I can understand, this is so that if in case the president is being driven somewhere, he always has the right of way.  (The president’s wife attends class here at the University.  I have not seen it yet, but apparently when she comes to class it is big deal with lots of security etc.).   There are only a few stop signs that I have seen, and they are really just suggestions, not a have to.  It is kind of a free for all, but the people that drive, seem to understand what they are doing and how to get around.  I am glad I don’t have to learn how to drive here!

I also went to my first church service here on Sunday.  It is a French/English service, followed by a service in Kirundi.  It was great, they do some songs in French and some in English, so that is nice, and the message is translated from French to English.  The people are lovely, and very warm and welcoming.  Everyone wants to shake my hand and greet me.  One little girl, probably about 3 or 4, walked up to me, hugged my leg and then walked away.  Another little boy, probably about 1 ½ to 2,  walked up and shook my hand and smiled, and then walked away.  The kids here are so sweet and adorable, and they stare at me a lot.  When I catch them staring and smile at them, they get huge grins on their faces.

My first class

I taught my first class this afternoon, and it was VERY challenging!  Probably the most challenging thing I have done in my teaching career.  I was escorted to class by one of the students (30 minutes late), and then had a couple of students helping me set up the projector to hook my laptop to for the PowerPoint.  As the students that were helping me were trying to decide the best place to put it, each time they moved to a corner of the room, all of the other students would move and turn their chairs towards that corner, so they could see well.  The students mostly crowded together towards the front of the room.  I started by saying, “good afternoon,” to which they all replied, “good afternoon.”  At this point, I thought, maybe they all understood English pretty well.  I then asked them to raise their hand if they could understand what I was saying…..and only about 3 people raised their hand!  Oh man, this is going to be a long summer!  It is stressful for me, but mostly I am concerned for the students.  I am hoping that they will be able to understand enough that they will be able to learn something!  They have a class delegate who speaks pretty good English, so he was helping me interpret some things, but not everything.  I think they understand the written words better than when I speak it, which makes good sense.    When I introduced myself and told them my name, many of them laughed.  I thought maybe being in a foreign country where all names would be unfamiliar to them, that they would not know that my name is typically a name for a boy/man in the U.S..  But, no, pretty much everyone I have met here so far has laughed at my name.  They are usually polite about it, but they do find humor in it.  The only problem is that my story of telling people that if I was a boy my name was supposed to be Cleve, doesn’t mean much to them, because they don’t see that there is anything wrong with that name.  I should have rethought things, and went by my middle name, Jonelle, while I was here J

Today I just went over taking a health history, and even though only a few people raised their hands that they understood me, I can tell that there are more that do…they are just very shy, especially the girls.  I had them work in groups to do a pretend health history on one of their classmates, and I think it went fairly well.  There are definitely the students that I can tell are interested and engaged and want to learn, and then there are others that are not.   The students all hold their cell phones in their hands here constantly, and when they get a call or need to make a call, they step outside of the classroom…not sure if I find this more distracting or less distracting then what my students in the U.S. do.  There were many students sitting in class, copying down notes from one of their classmates.  These notes were several pages long, and are from a class that apparently they have an exam in on Friday.    So, much like my students in the U.S., when there is an exam coming up, it is very hard to get them to pay attention to what I have to say.   I feel bad for the students, I am not sure why they had me start teaching right now, the students are just finishing up a term and have their final exams on Friday, and had me start teaching today…bad timing!  So, the students convinced me to cancel class for Thursday and Friday and resume on Monday with the understanding that class will be for a longer period of time each day next week to make up for the time lost.   Hopefully I haven’t been tricked!!

Since we will be going over health assessment, I asked the students how many of them had stethoscopes, as I held mine up.  Not a single person raised their hand.  How sad!  How are they to do their job and learn if they do not have the most basic tools?  The students I have in the U.S.  get a stethoscope usually the minute they find out they are going to nursing school.  This is so sad!

As I am sitting here typing this, I am listening to some wonderful drumming and singing taking place outside.   I can hear it, and but cannot see where it is coming from, or I would go get a closer look.  I have a feeling it might be part of a class, as they have a music degree here.   Burundians are famous for their drumming, and it is sound I have heard often while on campus here.  It is a beautiful sound!