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Several countries on the African continent have been set back by ongoing conflicts and political unrest - one of them is Burundi.
The poor and the sick are the first victims of conflict and the last to benefit from the rebuilding process that starts when peace settles. Burundi is the smallest and most densely populated country in Africa and one of the poorest, not only in Africa but in the world, ranking 169 out of 177 countries in the Human Development Index.
Some 68% of the population are undernourished, living for less than USD 1 a day, and the life expectancy at birth is 40 - 45 years. The higher mortality rate in all age groups, due to the presence of HIV/AIDS in Burundi, makes it difficult to state the exact number of inhabitants; although estimates vary between; 6.6 to 8.4 million people.
One would least expect diabetes to be a problem in Burundi, yet the World Diabetes Foundation has received and funded two project proposals. These projects are defying the odds and speeding up the conditions for improving diabetes care and prevention.
Empowering the health professionals
One of the projects, the “Community Health Care and Education Network” project, is run by APSA International Burundi, a non governmental organisation based in Mauritius.
APSA International (Association pour la Promotion de la Santé); was established in 1985 and has brought aid and assistance to the health care sector in Mauritius. Today APSA focuses on providing diabetes care and prevention. In addition the organisation is dedicated to provide aid to other African countries.
Project Manager Véronique La Hausse de Lalouvière, together with a team of APSA International, first visited Burundi in 2005, at a time when the political situation was stabilising and the country was shifting from a state of emergency to a period of more sustainable development. She realised that APSA could assist the Ministry of Health and help improve diabetes care and prevention in Burundi.
She was also able to meet with local professionals and representatives of the government who expressed a strong interest to collaborate in a diabetes prevention and education program. Following this incentive, APSA Burundi was created in November 2006.
Diabetes recognised as a health problem
The Ministry of Health is aware of the increasing rate of diabetes in Burundi, a disease affecting an ever growing number of civil servants in the country.
With peace, economic improvement and urban development, the population is shifting to a diet high in saturated fats, calorie-dense and processed food. The pace of nutrition transition is now proceeding very rapidly, at a rate never witnessed before.
These unhealthy choices have a direct effect on chronic diseases and diabetes has now become the third highest cause of hospitalisation in the capital city Bujumbura.
Also vulnerable are the immigrants from neighbouring countries who, due to poverty, survive on a very poor diet, making it difficult to either maintain optimal control or to prevent type-2 diabetes.
Doctors and educators trained to set up an educational network
APSA co-ordinated the training of health professionals, together with its partner in the project, ‘Diabète au Logis’, represented by Dr Xavier Debussche and Mrs Maryvette Balcou-Debussche.
The first training took place in June 2007, consisting of 15 doctors, 21 nurses, one dietician and 9 health educators who came from hospitals, clinics, local diabetes associations and area health centres.
With the support of APSA, these health professionals will identify new cases of diabetes, record existing cases and provide them with additional education.
Over the three years of the project duration, APSA plans to train 60 doctors and 60 nurses on diabetes care and prevention. In addition 30 educators will be trained to conduct health education sessions to targeted groups.
Mrs La Hausse explains that by the end of the project, the collected data will provide valuable information to define the burden of diabetes in Burundi in order to further help the government to develop a National Action Plan on diabetes prevention.
Sustaining hope for a better future for patients
The training aims to increase basic knowledge on diabetes prevention and treatment, and focuses on the approach towards patients.
“Some health care professionals have had a tendency to scare people with diabetes, to such a degree that the patients sometimes say they wish they suffered from HIV/AIDS instead. They do not get the full picture and are instead terrorized”, says Mrs La Hausse.
“I trust that this project will educate people in a more constructive way, giving them the ability to acquire knowledge and empower them to make life style changes with regard to their diet and physical activity”, she says.
Over a period of three years, 9,000 people will be screened and out of those, 3,000 diabetes patients, or ‘at-risk patients’, will take part in three to six follow-up sessions. Through a qualitative assessment approach, it will be possible to evaluate the impact of education on their life style.
APSA International is presently collaborating with local diabetes associations such as ALUDIA and APREPRIDA, as well as NGO’s, Handicap International and GVC (Groupe de Volontariat Civil), Infirmière Sans Frontière and SOS Village. The project has also received support from pharmaceuticals laboratories, Abbott (France) and ACON Lab (USA).
Unstable situation in Burundi
The people of Burundi have, since their independence in 1962, lived with and suffered under political and violent disputes between the two major ethnic groups, the Tutsi (14%) and the Hutus (85%).
Massacres in 1972 killed an estimated 300,000 of which the majority were Hutu. Since 1993, when the first ever president was elected and then shortly after assassinated; between 200,000 and 500,000 lives alone have been lost due to these conflicts. Hundreds of thousands of Burundians have been internally displaced or become refugees in neighbouring countries.
The WDF also supports another project in Burundi, strengthening the national diabetes centre “CELUCODIA” in the capital Bujumbura.
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