Day Two: Community-Driven

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 second entry of a two-part journal on her trip. Read part-one: "Maman Lumières."

We start early again today and meet with a chief of one of the health facilities in the Muyinga Province as well as one of the community health work coordinators (known locally as a TPS) for one of the communes we visited yesterday. They discuss with me how the project is implemented at the health facility level and how the TPS works as a middle-man between the health facility and several of the community health workers and the Maman Lumières ("illuminating mothers"), who are key community implementers for a positive-deviance hearth (PD-Hearth) nutrition initiative that began as part of the Maternal and Child Health project back in October of 2009.

The TPS oversees 58 Maman Lumières and 57 community health workers on a monthly basis. It is impressive to hear how the training and information about the PD-Hearth approach are working well in combination with the newly established protocol for the treatment of malnutrition at the community health facilities. There is a clear understanding, gratitude, and respect for every role in the project—from the Maman Lumires to the District Director. The TPS we meet with tells me that he is so grateful that Pathfinder is implementing this project because we are reaching the communities and people who would have been unreached otherwise.

This comment stays with me as we drive to another commune to meet with another group of Maman Lumières and mothers. We turn off the main road and continue to turn onto smaller and smaller roads until I am sure we will have to get out and walk. Several minutes later when we reach the center of the commune, I realize that it would take most of the day to walk back out to the main road, never mind to the health facility we passed 30 minutes ago in the car.

A mother and her small son meet us at the road; I learn later that the boy had gone through one of the home nutrition sessions developed as part of the PD-Hearth project and has since made an incredible transformation. Without fear or bashfulness, the boy steps up to me and reaches out his hand to shake mine. Laughter erupts amongst the women and, now embarrassed, the boy bounces down the trail and into the woods. The boy has been monitored closely by the MCH project staff and Maman Lumières for quite some time due to the severity of his condition prior to participating in the home nutrition session; sullen and listless before, he now runs in and out of our talking circle with the sense of adventure (and mischief) that could only be present in a healthy child. One of the Maman Lumières scoots behind him and chides him for interrupting; I tell her it is fine, I am very happy to see him so energetic and playful.

The gratitude expressed by the community for this project and the tangible effect it has had on the women and children is both humbling and overwhelming. I feel incredibly thankful for all of the community health workers and Maman Lumières out there in the hills walking every day in the rain and mud to share their knowledge, in their flip-flops or barefoot, changing lives one person and family at a time. We classify this project as a community-based initiative. But after spending just a few days with these exceptional people, I can say the project is not community-based; it is community-driven.

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