In Burundi becoming pregnant is a matter of life and death. According to the World Health Organisation, the maternal mortality rate is 11 for every 1,000 live births, while the neonatal mortality rate is 41 per 1,000 live births.

Since 2008, Médecins Sans Frontières (MSF) has been running a centre for obstetric emergencies in the town of Kabezi, south of the capital Bujumbura. The centre provides free specialised medical care during pregnancy and delivery, and treats an average of 250 women a month.

Mary Nicizanye, 30, is one of those women. She is sitting in the ward at the MSF centre. It has been four days since she gave birth to a little girl. Beads of sweat run down her neck, but her eyes are bright.

Before she gave birth, Mary was brought to a local health centre suffering from severe malnutrition. As her local centre couldn’t provide the blood transfusion she needed, she was transferred to the Médecins Sans Frontières facility in an MSF ambulance.

“More than 200 babies are born here every month,” explains MSF midwife Ann van Haver. “The goal of the project is to reduce maternal mortality. Most of the women who die due to their pregnancy die during delivery or in the first week after. That's why we give emergency care and treat women with obstetric complications.”

Mary’s newly born girl is sleeping in her mother’s lap. She was anaemic and underweight at birth and had been vomiting a lot, but she's much better now.

Mary is also feeling better. Her lips have regained colour and the swelling in her legs has decreased enough for her to started walking again. “If it weren't for MSF my children wouldn't have a mother”, says Mary, who now has a total of five children.

 Although Mary is happy to have had help to bring her daughter safely into the world, she does not know what to expect when she goes back home. Her husband didn't want to have anything to do with her after she became ill, and doesn’t know that she has given birth.

 Mary's mother is sitting on the bed beside her. She was the one who took Mary to the local health centre. She’s here as a grandmother today. Like many other grandmothers at the centre, Mary’s mother takes care of her daughter by preparing  the food provided by the Kabezi centre.

 Mary and her mother are happy that their little girl is alive and have named her Nduwakeza. In the local language, Kirundi, it means 'Good News'.

Photo: : © Sune Juul-Sorensen /MSF
Mary Nicizanye has named her fifth child Nduwakeza, which means 'good news' in Kirundi.

Free treatment for all

The health system in Burundi is still suffering the consequences of the civil war, which plagued the country from 1993 to 2006. Because there is no functioning reference system for emergency cases and because they cannot afford to pay for services, only about half of women in Burundi have access to trained assistance during delivery. In addition, emergency obstetric care is frequently unavailable and the quality of services is poor.

The centre deals with a number of different complications, including prolonged labour, bleeding, before and after birth, and pre-eclampsia (symptoms for this condition include dangerously high blood pressure). If a woman has had a caesarean there is a risk that the scar from that operation will tear during birth. All of these potential situations mean it is important that she is transferred to the centre where staff can intervene if complications arise.

Another possible consequence of untreated complications during labour is obstetric fistula. It is an abnormal opening between the vagina and the bladder, the vagina and the rectum, or the vagina and both bladder and rectum. The fistula develops over many days of obstructed labour. The resulting permanent incontinence causes most women who develop fistulas to become social outcasts. Obstetric emergency care like that which MSF provides can help prevent fistula.

It is estimated that there are about 1,000 new cases each year and a total of about 10,000 women suffering from untreated fistula in Burundi. In 2009, MSF organised a pilot surgical campaign treating 30 women. The success of this campaign motivated MSF to open a permanent fistula clinic in the town of Gitega, central Burundi, where a team will be able to treat at least 350 women a year. After the women have been operated on they are able to return to their normal life and be a part of society again.

The MSF centre in Kabezi offers services for a population of about 600,000 people. The project in Kabezi is run by 115 Burundi MSF employees and supported by eight international colleagues whose the primary task is training and coaching Burundi supervisors.