Burundi: MSF opens a centre for obstetrical emergencies in the vast suburb of Bujumbura

MSF is opening a new Centre for Obstetrical Emergencies in Kabezi today, in the vast province of Bujumbura Rural (with around 780,000 inhabitants), encircling the country's capital. This specialised centre constitutes an essential component of MSF's project, taking on referred cases and providing medical care for women presenting complications during pregnancy or delivery and who cannot be treated in health centres.

Since November 2006, MSF has been using three ambulances, a radio-based communication system and qualified medical personnel to refer these emergencies from a dozen health centres in Bujumbura Rural to medical facilities in the Burundian capital.  The transport and health care are provided by MSF free of charge.

Every month, MSF transfers between 72 and 111 obstetrical emergencies, culminating in between 42 and 81 caesareans. From now on, the new site situated in Kabezi will serve as a reference centre. With its 35 beds, the centre is equipped with an operating theatre, transfusion material and a maternity unit – essential elements in the specific case management of obstetrical emergencies.

"An obstetrical emergency arises when a delivery runs into difficulties," explains Dr Marc Postel, the MSF project coordinator for the last two years. "Complications arise in 15 to 20% of deliveries, and the mother has to be within reach of an operating theatre and a blood transfusion in order to benefit from emergency health care, and, as a last resort, a caesarean. The medical care offered by MSF is crucial because obstetrical emergencies place the mother and baby's lives in danger and can cause serious after-effects such as sterility or a vesico-vagainal fistula."

In the event of a complicated delivery, time becomes critical in saving the life of a woman who may already have lost several hours in reaching the health centre. In the MSF ambulances, a midwife or nurse with obstetrics experience can provide the specialised care that is so often not available in the health centres, and ensure medical monitoring during the transfer. The MSF project will be managed by a team of about 100 staff, including 8 international specialists – nurse, midwife, gyneco-obstetrician, anaesthetist, laboratory technician, etc.

The MSF programme has already provided life-saving care to more than 1,500 women since its initiation. It would be impossible to find this type of care for most cases in Bujumbura Rural, given the multitude of obstacles to overcome: the poor state of roads, the lack of specialised human resources, material and medicines, and of course the insecurity in the area.

But the main obstacle is undoubtedly financial. "I've seen women who've had to walk for hours before reaching a health post," relates Dr Marc Postel. "Many families are perfectly aware that these women are in a critical state, but they don't have the XXX Burundi francs required to pay for a taxi and medical care".

A presidential decree adopted in 2006 guarantees free health care for pregnant women and children under 5 in Burundi. Yet this free access remains an illusion for the population of Bujumbura Rural. MSF intends to draw on its project to bring attention to the scale of materno-infantile mortality in Burundi and emphasise the importance of accessible and free medical care in this domain.

MSF has been working in Burundi since 1993. In Bujumbura Mairie, the 'Seruka' centre of MSF provides medical and psychological treatment to about 120 victims of sexual violence every month. MSF teams also carry out awareness-raising activities in Burundi's capital. The second MSF programme in Burundi is located in Bujumbura Rural and focuses on obstetrical emergencies.