In 2015, humanitarian partners’ joint risk assessment in Burundi identified political instability and election-related violence as the highest risk of causing a large-scale humanitarian crisis in the country. Eight hotspot provinces were identified where humanitarian preparedness investments would make a difference, including Makamba province. Working with governmental and non-governmental partners, UNICEF decided to step up its cholera prevention efforts there, with DFID’s support.
It’s early morning in Gasaba village, Makamba province and the market area is already teeming with traders, goats and a steady stream of women carrying buckets of water. Makamba, which borders Tanzania, is a cholera endemic region. Clean water sources remain a challenge, despite the fact that Gasaba village is located just minutes away from one of Africa’s largest body of fresh water – Lake Tanganyika. Mariam Cubwa, a 71 year old grandmother from Gasaba, describes the excruciating pain she suffered in the grip of a cholera infection.
“I was very ill. I had no strength, the diarrhea and vomiting wouldn’t stop and my entire body was on fire – terrible fever. By the time I reached the hospital I was unconscious. If I’d not received immediate medical care – I’m sure I would be dead by now”.
“This project has literally saved countless lives in Gasaba village.”
Mariam is one of the fortunate to have survived her ordeal, largely due to the quick action of a series of partners including the Ministry of Health, UNICEF, CADEVI, AHA, and the Burundian Red Cross. The quick collaboration between partners in favor of cholera prevention and control has been hugely successful, bringing figures down to zero from 181 total cases since the onset of the Burundi crisis.
With UNICEF support, CADEVI has facilitated community-led initiatives for cholera control and prevention across the province. The ‘Door-to-door’ project has trained 120 “Friends of Health” peer educators, to follow up on community members like Mariam to ensure cholera prevention practices continue.
“Cholera awareness was very poor in this region prior to our interventions,” remembers Elie Niyoyambere, a “Friend of Health”. “Few people knew that cholera was caused by ingesting contaminated food or water. But the effectiveness of our programmes stems from the level of personal interaction and community participation. I travel with illustrations that reinforce hand-washing practices. But more importantly, I’m in their homes to help them identify areas of prevention, such as contaminated water sources. This project has literally saved countless lives in Gasaba village.”
“They all perished”
“I lost my sister, who was pregnant, and two of my nieces to cholera. When they fled, they lived in contaminated and overcrowded areas of Tanzania. By the time they got here they all perished”.
Denise’s story is tragic, but despite her loss, she sits with her community and a small group of children to participate in CADEVI’s focus and discussion group on sanitation and hygiene practices. CADEVI’s objective is to ensure that the message on cholera prevention and control is not merely an ‘adult’ problem, but a responsibility carried by every member of the community – including children.
For many communities, the issue of health, sanitation and cholera prevention can still carry strong socio-cultural and environmental barriers. Where is the most accessible water source? Whose primary responsibility is it to collect this water? How can a community member question safe water practices? With support from UNICEF, CADEVI uses ‘Transformative Theatre’ to help audiences tackle such sensitive topics and behaviors that negatively impact the community.
Informed choices, sustainable change
Once a week, CADEVI holds an open-air theatrical performance, using edutainment to question common practices on cholera. In today’s performance, the main character is a farmer who refuses to wash his hands before eating, but insists on a prayer for ‘protection’. The performance has its desired effect, engaging a crowd of over hundred people, who are unable to contain their laughter and eagerly raise their hands during the question and answer period.
Jacqueline Bankurugero, one of the audience members, commented on the performance: “There are many men in our community like the character in the play. They’re stubborn. They won’t listen to their wife’s advice on hand-washing… and who suffers? His son, who contracts cholera because of his poor sanitation practices”.
Chantal Bakuzako, Communications for Development consultant at UNICEF Burundi, explains why transformative theatre is so successful in promoting good cholera prevention practices. “Transformation theatre empowers communities by equipping them with a new knowledge base and a safe environment to question established norms,” she explains. “Decisions are not made for the community, but rather communities are encouraged to make informed choices that lead to positive and sustainable social change. Only then can we eradicate cholera in this region.”
And with communities newly equipped to prevent future cholera outbreaks in this endemic zone, a major step has been made towards reaching that goal.
Text and photos: Tiferanji Malithano