Healthcare in Burundi and DRC

Leading a research-action on community governance in primary health-care centres in Burundi and DR Congo

In October 2011, I came to Oxford to start my DPhil in International Development. I had just returned from a few years working in the African Great Lakes region for various NGOs and the United Nations. My DPhil would bring me back into Burundi and South Kivu, in the Eastern Democratic Republic of the Congo. I came to Oxford with a rough idea to carry out action based research in collaboration with a local NGO and the Ministries of Health. The partnership was already secured, and after working on the conceptual aspects of the project in my transfer paper, I was back to Bujumbura just a few months after I left it.

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I prepared my trip in much the same way I had done in the years I had spent in the field before starting my DPhil: I went to the embassy quite a few months before my expected departure, visited the tropical diseases doctor* who had advised me before, and, importantly, tried to get a sense of the evolution of the political situation in the field. The Foreign and Commonwealth Office (FCO) is not a key actor in the region so I also referred to the websites of other European countries (an important one turned out to be my home country Belgium). Even more importantly, I consulted extensively with contacts in the field to evaluate the level of insecurity on the ground. The African Great Lakes is a part of the world where you want to double-check these things. I also tested the reactiveness of my local partners - I knew from experience that a solid local partner would be my best insurance once in Burundi.

Going back to a place where you have lived before has its advantages, but also some drawbacks. On the plus side, I had a good sense of the health-care situation and the potential health hazards (indeed my work turned out to be on the health system). I also had a better understanding of how transportation and the city / country works than most newcomers and had some experience negotiating the visa system. Accommodation was arranged in just a few hours, with a couple of e-mails to friends. On the negative side,  I had become a bit less careful and perhaps a little complacent. Forgetting items that are not easily found in a poor, landlocked, post-conflict country only affected my comfort (and I could always ask somebody to ship me something) but forgetting the emotional and physical intensity of fieldwork put me down for a few weeks; The reverse culture shock caught me by surprise.**

 

CHALLENGES

  • Carrying out fieldwork in remote places (need local knowledge and transportation to get there)
  • Poor health services with limited possibility of evacuation
  • Working in an unstable area, pockets of violence

PLANNING

  • Thorough risk assessment, thinking through practicalities, logistics and contingency plans
  • Memorandum of understanding with the local organisation
  • Health check-up, first aid training, knowledge of local provision and options
  • Carry out extra security and safety checks in addition to  the FCO’s; use local contacts

LESSONS LEARNED

  • Do not assume that because you have visited  a country before, that the situation will be the same as when you left; even though you are going back to somewhere you know, get a ‘reality check’/update when you return.
  • Be flexible and ready to change your plans if the situation becomes unstable or  dangerous.
  • Fieldwork can be emotionally and physically intensive.
  • Look after your health, which includes getting plenty of rest.
  • Research plans can take longer than expected to put in place, so allow for this when planning your timescale.
  • It is important to consider your security, but also the security of research assistants and collaborators (as locals may be more vulnerable).

FURTHER INFORMATION

* Individual travel health advice can be obtained from the University Travel Clinic Country specific health advice can be obtained from Fit For Travel

Emergency first aid training for fieldworkers is available from the University Safety Office

** The Student Counselling Service offer an on line service for students away from Oxford

Facing an endless list of hassles, ‘tracasseries’ as they are called locally, when trying to put into practice the ambitious action-research plan I had designed, my best strategy proved to be sleep and rest. I took the time to ensure this; this time I had to manage a team in a culture where losing your temper is about the worst thing that you can do. Gradually, building trust with my team of enumerators and research assistants paid off.

Working with a team also implies new challenges, which I had not forecasted too well. I came to realise that my enumerators and research assistants were a lot more exposed than I was, as foreigners would rarely be the target of verbal or physical violence. Constantly re-evaluating the security situation, and in two notable instances cancelling data collection on security grounds, was crucial to ensure that the project would run until the end.

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