By Robert Ast
“Hell in paradise” is Deo Niyizonkiza’s description of his home country of Burundi, which was named the world’s poorest country by the World Bank in 2006. A place of striking natural beauty, Burundi has endured colonization, decades of misrule by dictators, and, most recently, a 13-year civil war between Hutus and Tutsis that, by its conclusion, had resulted in over 300,000 deaths and the displacement of nearly a million Burundians. The war also had disastrous effects for the country’s economy, and over half of the population now lives on less than a dollar a day. According to the World Health Organization’s latest figures, the average life expectancy for a woman is 47; for a man, 42.
Following the 2006 ceasefire, however, a few bright spots have emerged—perhaps none more encouraging than Village Health Works, a health center that Deo founded in his hometown, the rural village of Kigutu, in 2005. When he left 11 years earlier, fleeing the civil war, Deo had no idea if he would ever return, or see his family again. “We were separated when the war started,” he says. “I had no idea where they were. It’s one of those situations where it’s every man for himself. The people with me, we were all just running away.”
Deo found his way to New York via Rwanda and Paris and wound up homeless on the streets of Harlem. Through the intercession of some new friends a family adopted him as a surrogate son, and he worked a series of odd jobs and delivered groceries to chip in. “Working 15 hours a day, or even being homeless, I didn’t feel that it was that bad, given what I had just come from,” he says.
In his spare time he studied English and eventually enrolled in Columbia’s American Language Program before applying to the School of General Studies. At GS he majored in philosophy and took premed courses and, after graduating, attended the Harvard School of Public Health. While there he connected with Dr. Paul Farmer, one of the founders of Partners in Health, a public health organization known for its community-based approach. Deo began to work with Partners in Health in Haiti and, later, Rwanda, Burundi’s northern neighbor. “I was the only person in the group who knew the language and culture, and how to talk to patients and bring them to the clinic,” he says.
It was during a trip across the border to visit his family that the seed for Village Health Works was planted. “I knew that the country was miserable but had no idea that it was so bad,” he says. “It deeply affected me.” Citing a 2005 World Health Organization report, Deo notes that the total expenditure on health in Burundi is only 3 percent of its GDP, which in 2004 amounted to less than $20 per person. On average there is one doctor for every 34,000 inhabitants (the U.S. figure is 192 for the same number of citizens), and most hospitals lack even the most rudimentary equipment; many have even become de facto prisons, where armed guards detain patients unable to pay their medical bills—a direct result, Deo argues, of the user-fee policies set by the World Bank and International Monetary Fund, which require countries accepting their aid to charge even their poorest citizens for services like health and education. As a result it is not surprising that many impoverished Burundians turn to traditional folk medicine practitioners, who rarely alleviate and often exacerbate their conditions.
Clearly a new model was needed. After consultation with Dr. Farmer and his colleagues at Partners in Health, Deo founded Village Health Works, foregrounding the idea of community partnership in the center’s name. Three years later, the center is an unqualified success, treating more than 16,000 patients in just its first nine months.
Twenty-two local women sit on a steering committee, and a group of former soldiers are building roads and bridges to connect the center to the rest of the country; after observing Village Health Works, Dr. Farmer, recipient of a Macarthur “genius grant” and the Conrad Hilton Humanitarian Prize, found “an unparalleled level of community participation.”
Of course much still remains to be done. Already demand for services outstrips the center’s capabilities: maternity and pediatric wards are sorely needed, as is an ambulance. Deo hopes to be able to expand the center into a full-fledged hospital and splits his time between Burundi and the United States, where he raises funds and works to forge connections with universities and other institutions. But Village Health Works—which some Burundians refer to, only half in jest, as “America”—has already brought a new spirit of hope to the country. “For so many children born during the war, all they know is misery, pain, and blood,” Deo says. “It’s such a wonderful thing to see people kept apart for so long because of ethnic divisions coming together. Burundi is a place where there’s been no shortage of war, no shortage of misery—but it’s a perfect place where people who really want to do good can make a huge positive and lasting impact.”