Lighting the way: overcoming challenges at Ruhororo health center

Heavy rain pounds the road to Nyamugari Hill in the Ruhororo commune, Ngozi province, making our journey challenging. Upon arrival, we're welcomed by the sight of rooftops subtly etched into the hill's landscape, marking the location of the "Amis des Jeunes" health center.
This center, one of 23 in the Ngozi health district, provides an array of essential medical services for approximately 12,000 souls, with 7,560 adults and over 960 children under two relying on its care. The list of services reads like a litany of hope: maternity, emergency, laboratory, vaccination, pharmacy, and medical care.

Enter a man in a white gown. He invites us into a room, revealing the heart of this endeavor. The center is equipped with medical apparatuses - refrigerators, a microscope, a haemoglobinometer, a centrifuge, and more. Each piece of equipment, a testament to their determination in the face of adversity, yet they remain insufficient for the vast needs of the community. This corner of health, while small, showcases a steadfast commitment to provide the best possible assistance with what little they have.

Beside the man in the white gown stand two fridges: "We just have a solar panel to power these fridges. The 12-volt battery can't power both fridges. Its battery autonomy is only 5 hours.  This single fridge cannot provide the health center with the required capacity for all the vaccines, including those against COVID 19", he says. His name is Copens and he is a Vaccine and Medicines Manager. The feeling we have is that he’s a guardian of sorts in this labyrinth of challenges.

Our journey takes a turn into the laboratory... A young mother waits, a silently suspended between hope and despair. Unfortunately, the lack of electricity means the microscope cannot be used, leaving her problems unsolved.
"The Ruhororo health center hasn't had electricity for a week now because of a power cut”. - laments Gérardine, a laboratory technician at the center. – “Patients have had to return home without having had any medical samples taken", Like the young mother, many are often sent home, with medical diagnosis and treatments compromised and their hopes dashed.

The center, with its erratic power supply, stretches the limits of its capabilities, sending vaccines and medicines to be to be maintained in cold storage 20 km away, in the hospital of Ngozi.  Small solar panels power all the administrative and medical blocks, but they fall dramatically short in covering the actual need.

As we navigate further, we find ourselves in the waiting room. Evelyne, a pregnant woman, is preparing to leave, disappointment evident in her voice and her head bowed. "I had an appointment for a prenatal vaccination, but due to a shortage of vaccines, I have to go home” – she shares.  She must make the journey back in three days, a daunting 12 km trek from the health center, a significant challenge given her condition.

The center assists an average of 46 women monthly with deliveries and antenatal care. Evariste, the center's director, notes:"The lack of energy to run the electrical equipment means that we have to refer pregnant women to other health facilities, which are sometimes a long way away.We also sometimes postpone or cancel vaccination appointments for two-year-olds, which disrupts the immunization schedule for some patients and may put many children at risk of measles and polio epidemics".

Administrative functions are also hampered by the lack of electricity. Computers and essential equipment are barely operational, leading to delays in patient care documentation and vaccine and medicine inventory management. Emmanuel, the Medical Director of the Ngozi health district, expresses frustration: "Sometimes I can't even communicate with the people in charge of the health centers because their phones run out of charge",

The center's efforts to educate the youth on health issues including COVID-19, malaria, measles, prematurity, and compliance with the routine vaccination schedule are undermined by the inability to use educational technology, making impactful sessions challenging.

Our journey in this center on the hill, suspended between the tireless effort of providing help to the community and objective constraints that paint sometimes Quixotesque endevour, is coming to an end.

It is 6pm, and the lack of proper electricity does not allow to provide services any further. This predicament is not unique to Ruhororo but is shared by many facilities across Ngozi province and Burundi, plagued by outdated electrical infrastructure.

With the support of Canada’s Global Initiative for Vaccine Equity (CanGIVE), three health facilities, including the Ruhororo health center, will be powered with renewable energy. This will enable continuous and more effective use of tools and monitoring and warning of pandemic diseases such as COVID-19, and epidemics of measles, cholera, polio, and zoonoses. This would also help to remove the obstacles to continued access to quality healthcare and the response in isolated communities.