Day One: Maman Lumières (Illuminating Mothers)

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Pathfinder's Sarah Eckhoff traveled to Burundi in May to observe and document some of the programmatic elements and successes of our Maternal and Child Health Project. This is the first entry of a two-part journal on her trip. Read Part Two: "Community Driven."

It's just after 8:00 am, and we are on our way to the northeastern Muyinga Province of Burundi for a two day visit to some of the villages where Pathfinder is implementing the Maternal and Child Health (MCH) Project. I'm joined by two of our staff, who will help me navigate the technical elements of the projects and the local Kirundi language. The city of Bujumbura, where Pathfinder's main office sits, is nestled next to the vast Lake Tanganyika and surrounded by mountainous country. Our fearless driver, Napolean, is navigating up a curvaceous "hill" that is steep enough to make even Lance Armstrong surrender to walking. As I watch numerous women traverse effortlessly up the hill, balancing firewood and baskets on their heads, and men push bikes saddled like donkeys with supplies, I am humbled and awed by their perseverance—these people are extraordinary.

A few hours later, we arrive at the Kagari village in the Goshoho commune of Muyinga and are welcomed by a traditional Burundian welcome song. Shortly after, a woman begins a monthly information session for community members in attendance. The woman is one of the Maman Lumières or "illuminating mothers," named for the way they "lighten the path" of other mothers. The Maman Lumières are the key community implementers for a positive-deviance hearth (PD-Hearth) nutrition initiative that began as part of the MCH project back in October of 2009. PD-Hearth is an approach that identifies affordable, culturally acceptable, effective, and sustainable practices that are already being used by individuals within a community to prevent malnutrition; by seeing these behaviors, families are empowered to adopt better practices, even with limited resources and access to services.

The nutrition initiative is critical for these communities, where malnutrition among mothers and children—especially in remote villages—is common. Over the last few years, Burundi has faced a myriad of challenges—from internal conflict to rising food costs. Combined with the geographic isolation of these remote, hill communities, these challenges have resulted in high rates of extreme malnutrition.

Maman Lumières are trained to provide treatment for moderately malnourished children at home. This helps them reach out to their communities and alleviates the long distances and difficult terrain encountered when traveling to a health facility—a trip that can take a day of walking.

Following a province-wide screening for malnutrition cases, mothers with healthy, nourished children were identified for their practice of positive and sometimes culturally uncommon behaviors that resulted in healthy children, despite facing similar or worse challenges as their neighbors.

Today, I am seeing the success of the positive-deviance approach, as communities share the information they have gained from various health messages and trainings. I spend time visiting and speaking with four Maman Lumières from the area, and they share with me how they are seeing the hearth approach work in their villages. Children diagnosed in the screening with moderate malnutrition are referred to a 12-day intensive program where the children are brought to the home of a Maman Lumière and fed high-caloric foods, and their mothers are trained on the preparation of nutritious meals using readily available resources. The transformation of these children, as a result of their participation in these home sessions, has been so significant, that my colleague does not even recognize a few of them as they play around us.

Mothers of the children share with us that before the project, they were focused on keeping their children full, not what they fed them; their children were listless and could not play with other children due to lack of energy and chronic illness. Now the children are visibly healthy, laughing, and playing. Some mothers also share that they are now using family planning methods to space their pregnancies—another benefit of this project. As mothers and their children learn about food and nutrition, they are also more aware of other health needs. They now understand how spacing and delaying births helps them and their children to be healthy.

There is a man named Protazi in the group with us. He sits on his haunches, cuddling and kissing his son, Samuel. Protazi tells us that there was a time when the round and happy two and a half-year-old boy in front of us was very sick and malnourished. Samuel was referred to one of the sessions held at a Maman Lumière's home for treatment; Samuel's mother began sharing the knowledge she gained with her husband. Protazi became interested in what he was hearing and decided to come to one of the follow-up sessions himself to see if he could learn more. Now Protazi and his wife take turns bringing Samuel for his follow-up visits, and Protazi is actively sharing his knowledge and commitment to the program with other men in the community.

As we leave, I wonder and hope to myself if he will start of movement of Papa Lumieres in the community.

This was the first entry of a two-part journal on her trip. Read part-two: "Community Driven."

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