Bujumbura – "I'm diabetic and life here is very hard, very complicated," complains Jean Ndimurirwo, 68, who has lived in the Maramvya camp for displaced people, near Bujumbura in Burundi, since being driven from her home by floodwaters three years ago. 

A diabetic for 23 years, Ndimurirwo suffered several complications that required specialist intervention last year. "I used to leave the camp to go to a suburb of Bujumbura to see a diabetologist. But it's often hard because I don't always have the means to travel, and pay for the consultation and the necessary medical tests."

In camps like the Maramvya, which is home to more than 5 000 people, access to optimal health care remains a challenge, especially for those with chronic illnesses such as diabetes. In response, Burundi’s Health Ministry launched the Maison des Jeunes Mobile Clinic initiative in February this year, targeting camps for displaced people (IDPs) and rural communities.

Between February and September, almost 6000 people benefited from free medical consultations and treatment thanks to the mobile clinic, which is supported by the World Health Organisation (WHO), with funding from the Government of Japan.

In addition, nearly 2000 patients benefited from laboratory tests and 680 pregnant women from obstetric ultrasounds, while more than 15 000 people received education in areas including hygiene, cholera, gender-based violence, malaria, diabetes and high blood pressure.

Global Peace Chain Burundi is one of the non-government organization’s supported by WHO as part of this campaign to deliver better health care to vulnerable populations. "Free consultations in IDP camps are of vital importance because they meet the medical needs of vulnerable populations who would otherwise have little or no access to adequate health care," says Dr Brondon Niguel Vouofo, the organization’s country director.

From medical consultations to advice on sexual and reproductive health, ultrasounds, laboratory tests and measures to prevent and screen for communicable and non-communicable diseases, an entire  package of health services is offered. 

"WHO Burundi's support enables us to reach a large number of people in IDP camps, which greatly improves the quality of care offered to vulnerable populations," explains Dr Vouofo. "People screened for medical problems, including diabetes, receive appropriate medical care and advice on appropriate diet and lifestyle to enable them to better control the disease. »

In Burundi, hypertension and diabetes are two common and often associated public health problems. According to data from the District Health Information System 2 (DHIS2), Burundi’s more than 2-million strong population includes almost 38 000 people living with diabetes, and more than 98 000 others with high blood pressure. 

"The diabetes screening campaigns organised in the camps make a huge contribution to the fight against diabetes, because the surrounding populations also benefit. In this way, people know their status in time to take the necessary steps," says Dr Jean de Dieu Havyarimana, director of the National Integrated Programme to Combat Chronic Non-Communicable Diseases.

He points out that, in the absence of a national diabetes and hypertension register, these campaigns are extremely useful. "They allow us to populate our diabetes database, which helps our planning. » 

As part of the fight against noncommunicable diseases (NCDs), including diabetes, the WHO team at the Burundi Country Office is providing multifaceted support, including the development of strategies and policies that align with the country’s drive towards achieving Universal Health Coverage (UHC). 

"WHO, in its work to achieve Universal Health Coverage, must not leave anyone behind. In IDP camps, people often live in very precarious conditions, with few or no health facilities. This means that if particular attention is not paid to these populations, those with noncommunicable diseases could experience serious difficulties, especially in terms of treatment, but also in relation to the early detection of diseases such as diabetes," says Dr Jérôme Ndaruhutse, WHO Burundi’s NCD programme officer.

The country faces many hurdles in improving NCD management, including suboptimal planning and management of both human and financial resources, as well as access to care, especially for vulnerable groups. Against this backdrop, the screening campaigns and the consequent treatment for people in the camps offers hope to those living with diabetes.

"Since the doctors have been coming to visit us in the camp and giving us free consultations, I feel relieved," says Ndimurirwo. "My health has improved and I'm satisfied. - World Health Organisation

Government aided the removal of about 1.4 million (82.4 per cent) square metres of asbestos roofing from public and private buildings in the country as of October 31, according to the Rwanda Housing Authority.

The latest progress is in comparison to 1.69 million square metres of roofs countrywide that were made of asbestos. Some 300, 124 square metres of asbestos roofing still need to be removed. If poorly disposed of, asbestos fibre can be a dangerous indoor air pollutant and hazardous to human and animal health.

Health experts say the more one is exposed to asbestos, the greater the chance of developing lung cancer, asbestosis and mesothelioma, a type of cancer that develops from the thin layer of tissue that covers many of the internal organs. Asbestosis is a chronic lung condition that is caused by prolonged exposure to high concentrations of asbestos fibers in the air.

According to RHA, in general, an area of 81.8 per cent of government buildings no longer has asbestos roofing while

“Whoever has materials made of asbestos should first consider health and save lives. As the government strives to eliminate asbestos, people who still have them should follow suit to ensure their elimination,” the RHA stated.

Asbestos, once a popular material used in roofing, was praised for its durability and fire-resistant properties, but scientists later discovered that there were numerous health risks associated with having asbestos in house roofs.

Efforts to eradicate asbestos roofing in Rwanda started in October 2009.

How provinces are faring in removing asbestos

Eastern Province leads in terms of eliminating asbestos, with a removal rate of 92.7 per cent.

The City of Kigali stands at 92.5 per cent, Northern Province at 84.9 per cent, Western Province at 75.1 per cent and Southern Province at 73.6 per cent.

The coordinator of the asbestos removal project, Mathias Ntakirutimana, told The New Times that at least 900 companies were trained to help remove asbestos roofing across the country.

“We are sensitizing people to change their mindset. They should understand that it is no longer difficult to remove asbestos because many technicians have been trained. They can replace asbestos with affordable iron sheets. It is not something we are requiring them to do in one day.

They should have a plan and a target,” he said.

Ntakirutimana said the government trained builders’ cooperative members, police officers, land managers, members of the reserve forces, and correctional service officers, among others.

“These also help to report cases of buildings that still have asbestos. The removal of asbestos is very urgent,” he said.

In 2013, the government estimated that there was more than one million square metres of asbestos roofing that had to be cleared and disposed of by 2016, an exercise that was estimated to cost Rwf23 billion.

However, things later changed since the price to remove asbestos was reduced as a result of a growing number of trained asbestos removal technicians in addition to the increased number of asbestos burial sites.

Jean Rodrigue Munyaneza, a civil engineer, in 2020, told The New Times that the cost a private owner would incur amounted to a little over Rwf3 million. For an average 300 square metre family house, he said, the total cost would involve up to Rwf500,000 to remove the asbestos, Rwf1.5 million to buy new iron sheets, and Rwf600,000 for labour and painting, among others.

This is in addition to the usually unforeseen refurbishment or construction costs that go with it.

One also has to foot the bill of transporting the removed asbestos to a designated dumping site for safe disposal.

Talking about budget constraints, on Thursday, November 9, Alphonse Rukaburandekwe, the Director General of Rwanda Housing Authority, told The New Times that “currently, budget is not the main challenge to eliminate asbestos since the government put in more effort and achieved the asbestos elimination rate of more than 80 per cent.”

He said owners of buildings with asbestos were informed and asked to fast-track the removal of asbestos. - Michel Nkurunziza, The New Times

Irakoze Chanceline, a 22-year-old mother of four, arrived at the makeshift camp in Gatumba in March this year after floods destroyed her house and property. "I want my children to stay healthy," she said. "That's why I make sure they get all the necessary vaccines."

A small town bordering the Democratic Republic of the Congo, Gatumba has been battered by the torrential rains that have deluged Burundi repeatedly during the past three years. An estimated 10,000 have been left homeless. About 7,000 of them are sheltering in the internally displaced persons (IDP) camp where Irakoze and her children are staying.

There is a small health centre in the camp, Irakoze said, from which vaccination drives are coordinated. "The recent polio vaccination and other campaigns they find us at our tents, but also sometimes we are given dates to come and vaccinate our children at this health centre."

She has been advised, for instance, to return with her nine-month old youngest child when she is 18 months old. But she worries about further disruption: "The rainy season has started. Now we are worried about the floods again, and the hygiene of the places," she said.

Health worker Mushimiyimana Willermine, who works at the camp clinic, adds that sometimes the facility runs out of medicines and support.

 "We have doctors coming from health centres in Bujumbura, and the health workers have helped greatly here especially to maintain good hygiene. But we need more support from the government and other partners for this health centre to be able to accommodate all the people here," she said.

Cholera looms

Cholera is an increasing worry as the weather changes. Cases of the waterborne infection were recorded in Burundi even in the dry season, with the Ministry of Health declaring an outbreak in Bujumbura in early September. Now "we are into rainy season so there is a very high risk that the cases of cholera will increase, and what we can only do is to transfer them if nothing changes," says Mushimiyimana.

"We need more sensitisation on cholera, because the IDPs need to be sensitised about the measures to prevent the spread of cholera. Sensitisations were conducted, but are not enough, on how you can get infected, how to prevent and the cause [of cholera]," she added.

Mapping a path to safety

Burundi's government says it is working to make sure that the displaced people get access to health care, and to increase the human resources dedicated to preventing more property and life losses.

"We have now developed a multi-risk map. This helps us in planning and decision-making that makes it possible to understand the risks and better manage their effects, hence reduction in catastrophes," said Anicet Nibaruta, the Director General of the National Platform for the Prevention and Management of Natural Disasters. The platform is under the Ministry of Internal Affairs and is in charge of providing both early warning information and disaster management to the country.

According to Anicet, Burundi has lost some $98 million due to climate change related challenges. "We have studied risk areas including Gatumba, where a 2km dyke is being constructed to prevent the floods from river Rusizi," he said.

Despite the government stepping up their early warning mechanisms, health workers in Gatumba are calling for more support for their efforts to keep the IDPs in the makeshift camp healthy today. - Gavi the Vaccine Alliance