31 August 2015, Bujumbura – La Service Yezu Mwiza (SYM) in Bujumbura continued to offer essential treatment to people living with HIV and TB during Burundi’s recent political unrest. The Jesuit healthcare project faced an uphill struggle to keep its doors open, treating not only its usual beneficiaries but also others who came for medication.

Burundi was rocked by protests after President Pierre Nkurunziza announced on 25 April that he would seek a third term in office despite a constitutional two-term limit. In May, things got worse when army generals tried and failed to overthrow Nkurunziza. Dozens of people were killed in clashes between the protesters and security forces in several weeks of violence. Thousands fled their homes, many leaving the country altogether.

“During the unrest, it was so difficult to manage. We were never sure how the situation was in the city centre so we had to wait and see,” said Dr Tharcisse Nshimirimana of SYM, which gives medical treatment to 1,300 people living with HIV. 

“Some roads were barricaded and public transport was not working properly so not all staff or beneficiaries could reach the office. Those of us who managed to come to work treated patients who turned up, and we made more runs than usual with our mobile clinic to reach others, of course where the roads were not blocked.”

Since other organisations catering to people living with HIV were shut down in Bujumbura during the time of protest, the SYM also gave ART to some 40 patients who are not usually on its books.   

Dr Tharcisse said: “They informed one another that SYM had stayed open. We did not close because if we did, patients on ART and TB treatment, who need to take medicines daily, would not be able to get their medication. So we made as many efforts as possible to open everyday.”

The SYM staff also tried to make arrangements so that beneficiaries in remote rural areas could still get treatment from their nearest public health facility. They liaised with their local community mobilizers, who accompanied beneficiaries to get treatment where necessary. The government also announced on radio that anyone on ART should go to the nearest facility even if they did not usually do so.

All this was easier said than done, working with reduced numbers of staff and activities and hemmed in by restricted freedom of movement and the standstill or slowed operations of public facilities like transport and hospitals. 

“We also had a problem with patients who needed to be hospitalised because relatives were afraid to accompany them to hospital,” said Dr Tharcisse.

The delivery of medical supplies to the SYM was another challenge to be surmounted because the organisation in charge of the national distribution of ART was also not working properly.

“If you make an order of ART, usually it takes one day, but at the time it took a week,” said Dr Tharcisse. “However we didn’t have any shortages. As we saw that what was happening could take some time, we took the precaution of ordering early and got larger supplies than usual.”

The SYM usually does far more than dispense medical treatment and follow-up. Its beneficiaries get dedicated psychosocial and pastoral care; nutritional education, with food packages for those worst off; support for income-generating activities; schooling for orphans and vulnerable children. The team also goes to rural areas to conduct widespread activities for HIV prevention and to promote good healthcare. However all these regular activities were reduced because not only were many roads impassable, people were afraid to gather in groups at that time.

The situation is now calmer but remains volatile – “we still hear gunshots some nights and the explosion of petrol bombs in Bujumbura”. After the constitutional court gave him the go-ahead, President Nkurunziza was re-elected in a disputed ballot on 21 July that has left opposition supporters and international donors unhappy. And there have been two worrying targeted assassination attempts, one on either side of the political divide. 

Whatever happens, the SYM team will persist, insofar as they are able, in their efforts to reach people living with HIV because they know that failure to do so could have catastrophic results for those left without treatment.