The Road to Kigutu

Deogratias Niyizonkiza barely escaped the genocidal war in Burundi in the 1990s. Years later, he returned to the small African nation with a big idea. Can he heal what remains?

by Stacey Kors Published Summer 2014
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About an hour into the trip, the truck pulls into Rumonge, a dusty, ramshackle town and Burundi’s third-largest city. Niyizonkiza wants to visit the local hospital, the closest to Kigutu. There is a subsidized public health-care system in Burundi, where the average life expectancy is about fifty-two; but with the government spending about fifty dollars per person annually, the quality of services is inadequate. “Look how unsanitary it is,” says Niyizonkiza as he walks through the dilapidated buildings, where paint is peeling off walls, glass doors are broken, and window screens are torn and covered with dirt and debris. While many of the hospital’s patients suffer from malaria, tuberculosis, cholera, and malnutrition, many others are women with at-risk pregnancies.

Niyizonkiza enters the maternity ward, a dark, claustrophobic space jammed with women on rusted cots with ripped mattresses, pushed tightly up against one another. “Women come here straight from childbirth, from C-sections, still bleeding. Even if they live through childbirth, they often die of infection. And the hospital detains you if you can’t pay,” he adds. “It’s beyond dehumanizing. Many people would rather stay at home, and die at home, than come here.”

A few minutes after leaving Rumonge, the truck begins its ascent up the mountain toward Kigutu. At the base of the last road leading to the village sits an army barracks, where the soldiers who accompanied Niyizonkiza are dropped off. Another, standing guard, nods as the truck turns onto the seven-mile-long road, which is steep, winding, and unpaved. “This is UN refugee housing,” he says as the truck passes a handful of small brick structures. “It’s a TB incubator. There are often ten people living in one room, with no ventilation, no sanitation, no dignity.”

Niyizonkiza’s spirits climb with the altitude. Seeing people he recognizes walking up the road, he opens the window and waves. Shouting children run alongside the vehicle; an old man in a tattered blazer puts his hands together and bows. The road levels off near the top of the mountain, about six thousand feet above sea level, and ends at a security gate. A short, cobblestoned drive leads to a roundabout, in the center of which stand two flags: one Burundian, the other American. Niyizonkiza gets out of the truck, stretches, and smiles. “Now,” he says, “I can breathe.”

The Shannon McKenna Health Center, Village Health Works’ first building. / Photograph by Stacey Kors

This is Village Health Works, the nonprofit public clinic that Niyizonkiza founded in 2007. Situated on ten acres overlooking Lake Tanganyika and the surrounding mountains, with grassy berms, hedge-lined paths, and landscaped gardens, it looks more like a European-style sanatorium than a public clinic in a poverty-stricken African country. Entering the campus, he enthusiastically points to one of the many buildings. “This is the very first one we built,” he says. “We didn’t even know what we were doing. I keep waiting for it to collapse!”

As he strolls down VHW’s main pathway, Niyizonkiza grows increasingly animated, greeting people and sharing stories. He identifies other buildings along the way, including a community center and a new residence to accommodate his growing staff, which now numbers 265. Flowers are everywhere: a mixture of multicolored tropical varieties common to the region, such as birds of paradise and poinsettia, planted next to imported marigolds and asters. “I smuggled in a lot of seeds from the US,” Niyizonkiza says. “I wanted to create a place of beauty and dignity. A place of healing.

“There are many mass graves here,” he adds somberly, “buried under the lawn. The community told me where we could build and where we couldn’t.”

Walking through the heart of the clinic, Niyizonkiza descends from the plateau toward the lake, where about a hundred villagers have gathered. Men, boys, and women, some with babies strapped to their backs, are working a section of the hillside, flattening the land with hoes, shovels, pickaxes, and machetes. They sing, call-and-response style, as they work, hitting the ground in time to the music. “It’s the site of the future women’s health pavilion,” Niyizonkiza says. “We don’t have the facilities to perform C-sections here, or deal with high-risk pregnancies. In one month, we lost three community-health workers in childbirth.”

The workers stop when he approaches. Forty-two years old, five feet nine, and bald, with a slender build and a light, lilting voice, Niyizonkiza is far from an imposing presence, but he commands respect. He speaks to the villagers, whose traditional brightly patterned skirts and headscarves contrast with his gray pleated corduroys, pale-blue oxford shirt, and navy Brooks Brothers sweater draped around his shoulders.

“So many women have died,” one woman says. “To be here and help to control that death is a blessing for us. We come from different areas, but we’re united in our work, united in the hospital.”

“These are people who fought each other before,” says Niyizonkiza. “Yet they’re coming together to change things. They don’t want to wait for engineers and watch more people die. They’d build the whole thing if I let them. They’re unstoppable.”

Though it took more than twenty years for Niyizonkiza to realize his vision, he had been dreaming about establishing a clinic since he was a teenager. At fifteen, he tried to build his own clinic in the hills near his high school, convincing a handful of classmates and his father to help. “I lost many childhood friends, classmates, and neighbors growing up,” he says, “and it really affected me.” Unfortunately, after a relentless rainy season, the would-be clinic was washed out.

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Splendid article. Not surprising that Tracy Kidder wrote a book about Deogratias...

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