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Pathfinder Field Journal
Videos | Feature Stories | Publications
2009 Entries
Extending services in burundI
Burundi: Thursday, October 8, 2009
 Emma Buchumbi is a 30-year-old woman that I met in the province of Kayanza, Burundi (approximately 2 hours by road from Bujumbura). She is wearing a green scarf on her head and is breastfeeding her 9 month daughter Mireille Akimana. Emma is very shy, and she only speaks Kirundi, but with the help of Anne Marie, our community mobilizer, I was able to sit with her for half an hour and discuss our children, our lives, our hopes....Emma and her husband have a small plot of land where they plant mainly maize and kasava or manioc (as they call it in Burundi). She has four children, which she started having at the early age of 17. She did not give me any details about how she met her husband, and she just smiled and laughed at my very impertinent questions about her love life....she has never used contraception, but she does know that she should space her children....she said her children were spaced 3 years apart, which allows her to breastfeed them for at least 18 months. She took baby Mireille to get all her vaccines....eventhough Mireille is 9 months old, this was the first time she was being vaccinated. Emma tells me that the health center is too far away, and that she could not take Mireille before. Now, with the community promoters being trained in vaccination and in community mobilization, she was able to come to the "literacy center," which is just 300 meters from her home, to get Mireille vaccinated.
USAID and the Burundi Maternal and Child Health Project managed by Pathfinder International in partnership with Management Sciences for Health an associate award to the Extending Service Delivery (ESD) Project, is reaching further....is extending health services to the most vulnerable by working with community health workers is bringing the services closer to the people. The community health workers in Muyinga and Kayanza are all volunteers—modern time heroes—sacrificing their personal time and effort in providing preventive health care to their neighbors. A T-shirt, a pen, a registry book, a cap and an umbrella constitute their "tools." The Provincial Medical Officer in Kayanza, Dr. Eric Manirakiza, our most valuable partner, welcomed me with a warm hug saying "the muzungu is back!!"...and yes, I was back, and so proud of all the work that has been done in just 18 months!!! (Muzungu is the Kiswahili word for "white.")
Posted by Milka Dinev
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Discovering the secrets of the foresT
Guinea: Thursday, September 10, 2009
 “The elders go into the forest with the girls to show them the ‘secrets of the forest’, but do not cut them.” - young female focus group participant
I took my first trip as a Pathfinder employee this past May when I travelled to Guinea in West Africa. I spent my trip in the Forest Region—a unique part of the country. The Forest Region of Guinea has been off limits to development and aid workers for many years, due in part, to internal instability and neighboring conflicts in Sierra Leone, Liberia, and Cote d’Ivoire. Though the wars have ended, the years of neglect, accumulated displaced populations, and unmaintained infrastructure, make the Forest Region one of the most disadvantaged regions in Guinea. In a way, I felt privileged to go to such a remote place and have the chance to really “experience the field” and see our programs in action. Having previously lived in Senegal, I had certain expectations of life in Guinea. After experiencing Guinea’s deteriorating roads, sporatic electricity, and unhygienic and unmaintained regional health departments, it became clear that Guinea is much more the worse for wear than Senegal. This became even more evident after learning about the problem of female genital cutting (FGC) in Guinea.
FGC is so widespread in Guinea that nearly 96 percent of the female population between the ages of 15 and 59 have been “circumcised”—more than any other country in the region. This custom, often perpetuated and performed by women themselves, is seen as a requirement for entering womanhood. Using its community-based family planning program as a platform, the Pathfinder-managed Extending Service Delivery (ESD) project chose to address this issue by training former female circumcisers to become community-based distributors of family planning methods. This small pilot project simultaneously addresses the need for greater access to family planning at the community level, while helping former female circumcisers find a new, influential role, promoting healthy practices in their communities.
 I thought I might be intimidated by these women, having played such a substantial role in what I imagined to be a terrifying, painful, and life-altering experience for young girls. However, when I met them, they were gracious and kind, full of energy, and eager to participate in the workshop that we held to facilitate training. Initially curious and possibly suspicious of my presence at the workshop, they invited me into their circle and we danced and clapped together to kick off the workshop.
To learn more about these women and their opinions on both FGC in their communities and their role as family planning promoters, ESD hired local interviewers to interview the women into two groups, separated by age. During the session with the younger women, one woman spoke of the elders taking the girls to the forest and teaching them the secrets of the forest, but not cutting them. In other words, the elder women chose to continue passing down their knowledge and customs through the traditional “camp” or ceremony, but had eliminated the circumcision part of the initiation. Although the details and reasons of this are unknown, this isolated comment struck me as one woman’s acknowledgement of change happening in her community. Despite only being one observation in one village, it speaks loudly of the potential for reconciling tradition with healthy practices. This woman’s insight showed me that although the end of FGC may seem elusive, there are individuals who believe the practice is unnecessary. Maybe with more women like her beginning to question the need for the practice, communities will begin to see that the ‘secrets of the forest’ can continue to be passed down to young girls, without compromising their health and future.
*Pathfinder was recently awarded a grant to expand work to end FGC in Guinea. More information will be posted on Pathfinder's website soon.
Hope in Burundi
Burundi: Thursday, August 6, 2009
 In May of this year, after months consumed with resume revisions, networking, and endless email correspondence, I was finally able to turn my attention to finding a summer internship. Before long, I was offered an amazing opportunity: to work for the USAID-funded and Pathfinder- managed Maternal and Child Health Project in Burundi. Not being as familiar with Burundi as other East African countries, I jumped online to find out more details and what I might anticipate life to be like there.
Nestled among three countries—Rwanda to the north, Congo to the West, and Tanzania to the East and South—Burundi is home to more than 8,700,000 people, but is often the forgotten member of the East African Federation. Like neighboring Rwanda, Burundi was ensconced in a bitter ethnic civil war, which began in 1993 and lasted for more than 13 years, killing almost 300,000 people. However, my research yielded little more than superficial demographic and geographic information about this landlocked, densely populated country, and, I began to doubt the breadth and bias of my sources. Having traveled and worked in East Africa before, I was determined to keep an open mind. I packed my bags and headed out for what was sure to be a great adventure.
Upon my arrival, I was greeted with open arms and warm smiles from Raissa and Onesfore, two of Pathfinder’s staff, whose enthusiasm (in the early hours of the morning) was much appreciated after such a long journey. This was the East African hospitality I remembered—but of which the World Wide Web had made scant mention. I hastily dusted off my French-speaking cap, casquette perhaps a more appropriate term, and prepared for the weeks ahead. My past trepidations and anticipation were quickly put to rest as I began to adjust to life at home and at work in Burundi’s lakeside capital, Bujumbura.
 Life here has no fewer comforts and no more difficulties than the life I left behind, however the specific nature of both is notably different. The pole-pole attitude and lifestyle of much of East Africa is a welcome relief from the frenetic and stressful world left in Boston. This turn of phrase is Swahili, one of the three official languages of Burundi, meaning ‘slowly-slowly,’ encouraging people to slow down and smell the roses advice that greatly facilitates an enjoyable professional and social life. By contrast, corruption—a vestige of the recent war—is rampant in Burundi and often hampers the efforts of those people and agencies, like Pathfinder, who are making a genuine effort to improve the lives of its people. With many important service providers taking two-hour lunches, closing unannounced on any given day, and not making or keeping appointments, accomplishing tasks here often reverts to the age-old adage; it’s not what you know, it’s who you know. Nevertheless, Pathfinder staff work tirelessly around the clock with the goal of extending services to those who need them the most.
The fighting that threatened the lives of urban and rural Burundians alike is a not-so- distant reality for many and as people go about their daily business rebuilding what was once a peaceful existence, its memory seems to propel and motivate progress here. Despite the myriad obstacles (safe water, adequate housing, and employment among other things) that daily life brings for many Burundians, there is a tangible sentiment, a certain je ne sais quoi, in the air. This feeling beats in the capital and the provinces alike, and has the pulse of a people on the mend. I think they call it Hope.
Finding a Pathfinder Path in GhanA
Ghana: July 21, 2009
I spent three years with Pathfinder International at the Pathfinder headquarters in Boston. It only took me three weeks in Accra to find them again.
 Last Saturday afternoon I was walking back home after watching President Obama address Parliament. Just as I was about to turn off the main road, I saw a truck with a familiar teal logo pulling into a gas station. Could it be? It was! I ran over to introduce myself. I had found Clifford and Victor, Pathfinder staff from the Eastern Region who were in town for the day.
I should have known that I would see Pathfinders wherever I traveled, in spirit if not in the flesh. After all, it was obvious even before I left Boston in June that my time there had changed the way I see the world. I could no longer visit the doctor without running through a mental clinic assessment. Was the provider friendly and respectful? Did she counsel me on all my options for care? Were the fees reasonable? And if I weren’t relatively well-off, well-informed and well-insured, would the answers to those questions have been the same? (I was a delight to have in the waiting room, let me tell you.)
Now that I’m in Ghana, I have a whole new set of questions. It was one thing to be at headquarters, seeing Pathfinder’s work in terms of quarterly reports and hospital registers; it’s another thing entirely to be in-country, seeing Pathfinder’s work in terms of the people served.
Every morning on my way to the office I pass women walking up and down the lines of traffic, selling plantains for less than 25 cents a bag. Some of those women look to be in their third trimester. With an income of less than $5 a day, what choices do they have available to them to ensure a healthy pregnancy? In the women’s washroom at the Accra Mall, I saw a poster encouraging young women to know their contraceptive options. What are your options I thought, if you’re not wealthy enough to shop at the mall or if your family believes (like my cab driver the other day) that you shouldn’t be with a man unless he’s your husband?
 In my time at headquarters, I observed Pathfinder offices all over the world working tirelessly to make sure that these questions are being asked and answered in a way that makes sense for the men and women they serve. In Ghana, for instance, Pathfinder supports peer educators who are working to increase awareness of and access to sexual health services at a local university. They’re doing what I’ve come to see as quintessential Pathfinding working within their communities to ensure that they, their friends, and their families have the right and opportunity to a healthy reproductive life.
If just seeing the work Pathfinder does in other countries was enough to forever change the way I look at the world, I can only imagine the transformative effect of being a part of that work in your own community. Pathfinder is in 26 countries right now, working with hundreds of thousands of doctors, nurses, peer educators, and community health workers. That’s a lot of Pathfinders. When you look at it that way, the only real surprise is that it took me as long as three weeks to find them.
Awakening: Challenges and opportunities in Gwoza
Nigeria: April 1, 2009
To start the process, just few hours after my arrival after two days of travel, I met with the local team, composed of Dr. Sada Danmusa, Associate Director of Programs, Kaduna Office and Mrs. Jumoke Azugo, Monitoring and Evaluation Officer, from Pathfinder’s Abuja Office. Our agenda was to conduct a joint review of the objectives and expected outcomes of our trip and to finalize logistical arrangements. After productive discussions we declared ourselves ready to go.
In the early morning of October 5th we began a 10-hour drive from Abuja to Maiduguri, the capital city of Borno State (located in the northeast region of Nigeria). During our drive, I thought to myself how lucky I was to be part of this journey from the central to northern region of this beautiful country, which like mine is rich in tradition and culture.
 The 10-hour drive, though long, was truly a gift—I was offered a glimpse into the ordinary lives of men and women of Nigeria. I observed them working shoulder-to-shoulder on their land, caring for their subsistence. Some of the land was lush and green, not only as the result of hard work but also thanks to water access; in other areas without water patches of land were not as productive despite the hours of labor. It was painful to think of the consequences that a season without crop production would surely have for family incomes. I must also note that it was not uncommon to see children working along with their parents, and that pregnant women were not exempt from the labors of food production.
Reflecting, I felt there were many common historical realities in Ecuador and Nigeria. In Ecuador as in Nigeria, historically large families were expected; pregnancies occurred early in a woman’s life and frequently thereafter. Pregnancy and delivery were perceived to be natural events rather than medical. In Ecuador, and many other countries of the world, Pathfinder International along with local NGOs developed and implemented contraception/family planning community outreach programs and created cadres of medical providers who could offer quality reproductive health services. Over the past several decades, access to much-needed reproductive health services has increased. These reproductive health efforts have contributed to increasing contraceptive prevalence and decreasing maternal and neonatal mortality. So, while traveling through a different and distant country and seeing challenges, I was reminded that initiatives implemented over two decades ago have proven fruitful and I began to dream about the same possibilities for Nigeria becoming a reality.
Although the journey to Mauduguri was long, it was exceptionally pleasant and engaging; the change in landscape, the periodic call to pray together, and a rich dialogue with my Nigerian colleagues transformed a potentially arduous trek into a pleasant and very informative trip. I was looking forward to visiting Gwoza, meeting with Pathfinder’s partners and collaborators, and learning more about the challenges and successes of one of our programs. Anticipation grew when Dr. Sada told me that Gwoza was right behind a mountain visible from the road—he was right, in just 30 minutes we arrived in Gwoza.
As soon as our team arrived, we were ushered into the Local Government Agency headquarters where more than 40 citizens were awaiting our arrival. It was an overwhelming feeling—it was a very humbling experience to hear through a translator the expressions of gratitude towards the organization I was representing, “Without Pathfinder’s interventions the men and women of this community will not be enlightened with information on safe motherhood” or “Without Pathfinder our women will continue to die” were some of the feelings expressed by local authorities and religious leaders.
Dr. Sada Danmusa, speaking for all of us, thanked the group for their commitment and interest in supporting Pathfinder’s initiatives and most especially the safe motherhood work. He acknowledged the time they took to travel from distant communities and hamlets to meet us and the wonderful opportunity this provided us to learn from local community workers, health providers and authorities—including religious and traditional leaders.
During our visit we listened to the men and women of this community, the health peer educators and moblizers, describe their outreach strategy—which is simply using every opportunity they have to disseminate safe motherhood health messages. Indeed, they bring it up during conversations after religious services, they conduct home visits, they carry their message to public events and at the market place—there is not a forbidden time—Pathfinder has empowered them with information and they are going to share it!
Some providers testified that indeed more women are attending prenatal care. “Their husbands are coming along with their women” was reported by a midwife. “They are coming early in their pregnancy and have multiple visits” was reported by the maternity matron. However, despite a positive change in behavior during the pregnancy, we continue to face challenges when it comes to dealing with obstetric emergencies. Women arrive too late in an obstetric emergency. Providers said the communities often “wait and wait until the patient is not in good shape” and the sad thing is that “sometimes there is nothing we can do.” Providers’ testimonials on women, their husbands, and extended family challenges when it comes to emergency obstetrics were numerous and wide-ranging. Difficulties in obtaining transportation (of any type) to transfer women from the community to a health facility ranked high on the list. Even when transport is available, terrible road conditions often create another big hurdle for women and their families.
Travel distance cannot be measured in kilometers alone. Road condition and the season of the year are important factors when making a decision to transport women in need of emergency obstetric care. In addition, the decision to move a woman from the community to a health facility is a complex and collective process, one in which (as I was told repeatedly) tradition and religion weigh heavily. My Nigerian colleagues and the providers who were interviewed acknowledged the numerous hardships they face in increasing access to safe motherhood services. At the same time they referred with great enthusiasm to community champions who have served as catalysts for behavior change. One such champion among the many we found is the head of the National Union of Road Transport Workers who has agreed to provide a driver when an obstetric emergency arises.
Our two-day visit to Gwoza came to an end on October 7th. The following day continued our journey and to carry on a similar process in another community in Kano. But before closing the visit to Gwoza, my Nigerian colleagues and I made time to reflect on the highlights of the exercise—we concurred that although much has been accomplished there is still much to be done. We felt reenergized and moved by the enthusiasm and commitment expressed and shown by the community workers, health care providers, local authorities, and religious leaders.
The next day, we moved on as I continued my more than month-long journey throughout this amazing country. But my experience in Gwoza continues to stay with me as an example of all I saw during that time. What a privilege for me to be hosted by a community of exceptionally warm and generous individuals. I was humbled by the experience. I will be forever connected to this small community located in the northeastern corner of Nigeria and look forward to a time when women will no longer face the challenges they do today.
Video: Strengthening Reproductive Health in PNG
Papua New Guinea: January 8, 2009
Cody Swift, a Pathfinder supporter, traveled to Papua New Guinea in 2008. Watch a video he created about Pathfinder's work. Learn more about Pathfinder in Papua New Guinea.
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