The Mupfumu and Medical Care in Burundi

The Mupfumu and Medical Care in Burundi

I wrote in last year’s blog about the mupfumu (the traditional healers). Once will not be enough, for I am forced to write about them again. I was reminded again today how dangerous they are. I was equally reminded what a firm hold these charlatans have on the people of Burundi. The mupfumu are the anti-Robin Hoods: they steal from the abjectly poor so that they themselves can become rich (rich by Burundian standards anyway).

The readers of this blog, or, frankly, any blog, must find it difficult, if not impossible to believe the stories that I tell about the mupfumu. I myself would not believe the stories, if I did not know them to be true. Here is an e-mail that I received from Melino just before I left:

Yesterday, a 20 year old woman came at the clinic with a very sick baby: a 14 month old. The baby was malnourished because the mother stopped breastfeeding when the baby was 8 months of age. The reason she stopped was, of course, the fear of the "maladie du sein". The Mupfumu told her to find a rat and kill it and give the rat's blood to the baby. He recommended that she mix a cup of blood and tea spoon of coca cola. She did that and gave the blood to the baby. Unfortunately, it didn't work. She decided to bring the baby to the clinic. When I saw the baby, the mom told me that she knows why the baby is sick. I asked her why. She told me that the baby didn't get better after taking a cup of rat blood and would like to have more.

I wish that the above was an atypical mupfumu story. It is not, for the mupfumu are all the same. There are certain notorious mupfumu near the Tanzania border, who claim that they can cure AIDS, tuberculosis, diabetes, and, basically, whatever else one might have. They do so by the use of herbs. Many patients go to these mupfumu. A number of our HIV patients stopped taking their medications, and, instead, went to them. These misguided patients believed that the mupfumu and their herbs would cure them. It is a given that these patients eventually ended up back in the clinic, needing to re-start their treatment.

There are a thousand other examples of mupfumu misdeeds. I will restrict myself, in this blog post, to giving you two. Those two were women who came into the clinic Friday morning.

The first is a 34 year old woman by the name of Colasha Ngogusenga. She lives far from the clinic, in an area near the Tanzania border. Approximately two months ago, her abdomen started to grow in size, and not because she was pregnant. At the same time, she developed nausea and other unpleasant symptoms. The abdominal size continued to increase almost exponentially over the next month. Her abdomen was now so swollen that she had difficulty breathing.

That was when her husband insisted on taking her to the mupfumu. The mupfumu performed his usual technique of scarification. This consists of making multiple, relatively superficial, horizontal cuts in many areas of the abdomen. The woman’s condition continued to deteriorate, and the husband once again insisted that she return to the mupfumu for further treatment. This time, the mupfumu’s diagnosis was that she had a snake in her stomach; not just any snake, but a python. The only way to rid her body of the snake was to make a kind of soup out of the herbs he prescribed. She was to drink this soup three times a day.

The woman had no faith in the mupfumu. She did not want to drink the herb soup. However, her husband was one of the mupfumu’s devoted followers, and he insisted that she drink the soup. This is a male dominated society, so you can guess who won. However, she achieved a partial victory by throwing it out when her husband was not there.

It was only when the neighbors intervened that the woman, with the husband’s consent, was able to seek medical treatment. She had now been sick for two months, and her abdomen was grossly swollen. She lives far from here, and there were many closer hospitals. However, she decided to come here to the clinic in Kigutu. Why? For the same reason that so many other patients come from so far away: because they have heard that one gets better if one comes here. We are their last hope. Such was the case with Honorine, my five year old with the brain tumor.

I have seen a number of patients come here in what are the final stages of a disease process. Usually, that disease process is some type of malignancy. There would be no hope, no matter how advanced the medical care. They believe that we will cure them, as ill as they are. We cannot, nor could anyone do that. Yet, they are reluctant to leave the hospital until that cure is accomplished. We do good work here, but we cannot perform miracles.

This 34 year old woman, Colasha, traveled two days to get here. She was seen by Melino. I now show you pictures of her. The obvious image that you see is a grotesquely swollen abdomen. Far less obvious are the mupfumu’s lines of scarification. They are most prominent on both sides of the lower abdomen.

Melino’s ultrasound gave us an all-too-accurate picture of what this woman has: her abdominal swelling is a result of advanced ascites (fluid in the abdomen). The ascites itself is secondary to equally advanced cirrhosis of the liver. This is an incurable condition, and we have no treatment for her. The only thing we were able to do for her was to drain off three liters of fluid from her abdomen. This has given her temporary relief, so that she can breathe easier now. However, the fluid will quickly re-accumulate, and she will be faced with the same problem in the very near future. This is a woman who is only 34 years old, and her life expectancy is less than a year.

Liver disease is extremely common here, with a disproportionate number of young people being affected. We don’t know why there is so much liver disease. For instance, this woman’s cirrhosis is not a consequence of Hepatitis B or Hepatitis C infection. Moreover, she does not drink alcohol to excess. Therefore, we do not know the etiology of her cirrhosis. Perhaps there is an environmental toxin of which we are unaware. It is certainly possible that the herbs used by the mupfumu have a deleterious effect on the liver. Whatever the reasons, I have been disheartened to have already seen several cases of advanced liver cancer in relatively young people: all less than forty years old, and one in a nineteen year old boy.

The second case is as much an indictment of the Burundian medical system (or lack of medical system) as it is of the mupfumu. The patient in question is a 25 year old woman by the name of Frolide Ndayikeza. She is unmarried, and had no children. Her story is as follows: approximately three years ago, she developed abdominal swelling in the lower part of the abdomen. That swelling has gradually increased over those three years. During that time, Frolide consulted her mupfumu on multiple occasions. He performed scarifications, and given her herbs on those multiple occasions. Finally, in desperation, Frolide came to the clinic. Here are photos of her. The pictures look remarkably similar to the previous woman. Frolide also has a markedly swollen abdomen. Her lines of scarification are faintly visible on both sides of her lower abdomen.

Melino, once again, performed an ultrasound on the patient. The ultrasound revealed a massive growth in her abdomen. It extended from the base of her pelvis to the bottom of her sternum. It went all the way across her abdomen. The growth measured at least 30 centimeters in both horizontal and vertical directions. It was also 15 centimeters in depth. This was clearly a slow growing process, for it had taken three years to get to that size. In addition, it was, on the ultrasound, homogeneous in its consistency. Therefore, this is presumably a benign tumor. Based on the information we have, the most likely diagnosis is a uterine fibroid tumor. But how could a fibroid get that big? If one does not have access to medical care, and, instead, one continually goes to the mupfumu for treatment, a fibroid could get that big. I was told by one of my Burundian medical colleagues at the clinic that he has seen fibroids removed at surgery weighing more than twenty pounds. I would imagine that this particular fibroid weighs that much. Frolide only weighs 42 kilograms (92 pounds). Take the fibroid out, and she will be down to about 32 kilos (70 pounds).

So what will happen to Frolide? In an ideal situation, the tumor would be removed and biopsied. If, as expected, it is a fibroid, theoretically, she would be cured. It would not be a simple operation, considering the size of the tumor. However, it could safely be performed without undue risk to Frolide.

The problem is that such a surgery would require money. The estimated cost of the surgery is approximately $1,000. It is a given that Frolide does not have $1,000. It is almost a given that she does not have five dollars. She cannot afford the surgery. She has a benign tumor: one that should be curable. Yet she will not be cured. The tumor, simply because of its size, will eventually cause complications that will prove fatal. Already, one of those complications has occurred. Her abdominal aorta has been compressed to such a degree by the tumor that she now has high blood pressure.

Let us say, for argument’s sake, that Frolide could somehow raise $500 for the surgery. That $500 would allow her to have the surgery. Then she would be obligated to pay the remaining $500 before she left the hospital. If she was unable to pay that residual sum, she would be kept prisoner in the hospital until she did so.

Lovely medical system they have here, isn’t it? But, as I have said so many times in my blog posts, such is life in Burundi. It is not fair. It is not just. It is not humane. We at the clinic do what we can to make life better for the people here. But we are only a small piece of the much larger puzzle that is Burundi. One can only hope that the day will come when all the pieces of that puzzle are in their appropriate places. It is only then that life will get better for the Burundians.