Last One Standing (?)

{NOTE: I really did not feel that what the world needs now is yet another post about COVID-19. However, we are in a bit of a unique situation here, and felt it’s worth sharing}

So it appears that as of today, Burundi is one of the only countries in the world to have no confirmed cases of COVID-19.

In some ways, it feels like we’re the village in the French comic book Asterix, the only village in the known world not to have been conquered by the invading Roman powers.

We’re that little village way up there on the left under the magnifying glass – the only ones left.

There are several obvious reasons why Burundi would be slower to get hit than many others. There is limited international travel compared to a lot of other places, most of the population never travels very far from home (rarely more than a 1/2 day walk), and especially since the violence around the last election we have been essentially socially distancing from the rest of the world to some degree for five years now. This partially explains why many places in Africa have been weeks behind other parts of the world when looking at the spread of this virus. According to officials here, there have been several tests conducted so far, all of them negative.

Our hospital admin has been busy trying to prepare for the imminent arrival of the virus. Hand washing, eliminating group gatherings, and additional protective protocols have been put in place however they can be. Outside of our hospital, people are still gathering in huge groups, crowded churches are still crowded, schools are still in session. This includes public school here in Kibuye where there are routinely over 100 kids in a room, and often 3-5 kids at a desk, and one single water tap outside the outhouses for the 1,000+ kids. Public transport is still 20+ people crammed inside a Toyota mini-van, though handwashing stations are now set up at the main bus station in the capital.

So in a way, it’s tempting to feel like we’re on the beach, and we see the tsunami coming. And there are others on the beach looking the other way.

It’s tempting to look around and feel like we know what’s coming. But that’s not entirely true. The truth is this may very well look different here than in other places.

In one way, the entire concept of flattening the curve seems odd here. The premise in other places is to reduce the concurrent number of sick people to keep that figure below the capacity of the health system to care for them. To know what flattening the curve means, many other countries have been running tens of thousands of tests, and the resulting positive results show what the repercussions could be for the medical system. Here even if we had those kinds of results, I’m not sure they’d provide a lot of actionable info.

The estimates seem to be that the US health care system had at least 65,000 ventilators for 330 million people or around 5,000 people per machine going into this pandemic. Clearly, this isn’t the only indicator of the capacity of the system, but it’s a significant one. So if the transmission is slowed enough that no more than than one in ~5,000 people need a ventilator at a time (obviously ignoring localized demand and a lot of other factors) then the system should be able to cope reasonably well, at least from a basic equipment standpoint.

Here we’re looking at over a million to one. We’ve heard there are 10 ventilators in the country, all in the capital, for well over 10 million people. At least 9 million people live outside of the capital. There is no flattening of a curve that can make the number of concurrently sick people stay below that number. The population here is young, but it also has a high level of malnutrition, lots of TB, annual epidemics of malaria, and other factors that are not going to make it easy for most people to fight off the worst of this disease.

If watching this virus sweep through some of the wealthiest countries in the world shows anything, it’s that the illusion of control that most western societies hold so dear is finally showing itself to truly be an illusion. Here, I think there is a wider acceptance that we, as individuals and society, do not have the ability to control what happens to us. I don’t sense that an event that rocks society to its core is as unfathomable here as it was in the West a few months ago.

I read an African economist the other day saying that stay-at-home orders are essentially irrelevant in many societies in Africa where the majority of the population are sustenance farmers. If you work for one day to be able to feed your family that day, staying at home is not an option. Tending your rice and bean crops is not something that can be done remotely. Working from home when you have neither internet connection, nor a computer, nor electricity is something completely different than in the west. When your work is entirely you showing up and conducting some kind of physical work on-site, it’s a bit harder to do that over a Skype call.

Also if we were to lose the ability to go to the store it would be essentially meaningless here in Kibuye. There are a few ladies with vegetable stands along the road outside the hospital, but that’s about it. There is a larger market down on the main road – but again everything outside. There will be no run on the stores because no one has the disposable wealth to make a run on them, even if there were stores. And also, there is nothing pre-packaged or manufactured that people could offer up to be sold en masse. The day’s vegetables are sold that day, bought that day, and eaten that day for most people. Not much really is going to change that. This is significantly different in Bujumbura – as there are some stores, restaurants, imported goods, packaged things, disposable income, and people who could do work remotely. But up here, that really isn’t the case.

These are people who know how to live in difficult situations. They know resilience. They know creative problem-solving. And, unfortunately, they know sorrow and loss of life on a large scale.

I don’t claim to have any idea what it will look like here when numbers of cases start to look more similar to other countries. But my guess is that if we get to that place, some of the impacts we are now seeing elsewhere will have greater consequences, some less – but like everywhere it will not be pretty.

One only gets through this by working together – so hopefully here, that can make a difference.


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