Ekip Solid: A Conversation with Dr. Melino Ndayizigiye

Dr. Melino Ndayizigiye grew up in a remote village in Burundi, the ninth of 10 children, born to parents who had never set foot in a school but made sure their children did.

His parents were subsistence farmers. By the time Melino—known to most by his first name—was 3 years old, his father was teaching him how to take care of animals, a passion he carries with him today. His father died when Melino was in 10^th grade, just a teenager and suddenly scrambling to help his single mother make ends meet.  

The loss increased Melino’s drive to succeed--to do whatever it took to change his life and his family’s circumstances. And it inspired him to help others born to similar hardships When he was 17, a potential path to those goals appeared.

That was the year that Melino became very sick.

He was at a boarding school in Kiremba, in southern Burundi and far from his home, when he developed a fever, severe back pain and nausea. He was admitted to a small health center, but the facility had no lab, no x-ray or ultrasound machines—nothing besides a few medications on a shelf.

At that time there were no cell phones, so the only way for Melino to inform his family of his illness was to write a letter and find someone who could travel to his home to deliver it. But it was not easy to travel at that time, because Burundi was in a civil war.  

He thought he might die without his family knowing. It took more than three weeks for them to learn that he was sick.

Finally, they heard the news—and after almost a month in the health center, Melino was still so sick that his family took him to Bujumbura, Burundi’s largest city, for care.

There, at Roi Khaled University Teaching Hospital, was the first time in his life that Melino met a doctor.

Melino recovered, and several years later began medical school—at Roi Khaled, where the doctor who had cured him became one of his professors.

What followed in the years since—completing an emergency obstetric and surgery program, working at a remote hospital just before the end of the civil war, graduating with Harvard’s first global health delivery class, joining Partners In Health in Lesotho—is far too much for one conversation.

But here’s an attempt.

In the following* interview, Melino, executive director and former clinical director for Bo-mphato Litšebeletsong Tsa Bophelo, as PIH is known in Lesotho, shares his story for our ongoing series, Ekip Solid. Meaning “strong team” in Haitian Creole, Ekip Solid is a series of conversations with PIH global leaders about an array of topics, personal and professional.

You completed your medical internship in 2006, did your dissertation in 2007, and worked as a physician at a private hospital in Bujumbura. Can you describe that experience?

It was a time when Burundi was about to finish its civil war. We had had a long civil war for over 13 years, and when I graduated, many physicians didn’t want to go to rural areas, because it was not safe. Also, there was not a signed peace agreement between the last rebel group and the government, so people were reluctant to work in rural areas.

As someone who was born and raised in a remote village, I decided to go. I applied for a job with the Ministry of Health, and they appointed me as medical director in a district hospital in a rural area. I was the only physician in that hospital, serving a population of close to 200,000 people. I worked there for about a year.

For the whole year, I worked like a machine. Being one physician in a remote district hospital, you can imagine. It meant working day and night, dealing with all sorts of emergencies and conditions.

Around that time was when you first met Dr. Paul Farmer, PIH’s co-founder and chief strategist. How did that meeting occur?

It was by chance. Paul Farmer came to Burundi in 2008, with a team from Village Health Works (a nonprofit that provides quality, dignified health care in Burundi). He spoke at a conference in Bujumbura, at the National Institute of Public Health, and I was there. He inspired me a lot. When he was presenting about problems of health in the developing world and what PIH had been doing in different countries, such as Haiti, I got really inspired. I remembered how I had grown up without any access to health services.

After Paul Farmer and the team from PIH and Village Health Works did their presentation, I spoke with them, and they asked me to join Village Health Works. It was just at the beginning of the project.

I became the first medical director for Village Health Works. We often lived in tents. We worked hard, and we improved things in rural Burundi.

And yet, lingering dangers remained from the civil war. Did that affect you?

(Note: The following paragraphs describe traumatic violence.)

On July 13, 2009, I got ambushed. It was early in the morning, and I was traveling to our clinic. It was on a slippery mountain road.

We were ambushed by a group armed with AK-47s. They told us to give them money, cell phones. They told us that they were going to kill us. And they came to me; they knew I was the only physician in that region. One man pointed a gun to my head while others surrounded our car, insulting us and telling us it was our last day.

I had been working day and night to provide health services to patients. To me, I felt like I didn’t have any enemies. But to my surprise, one of the men decided to shoot, and killed my driver.

Our car started to roll back, and the murderers started to shoot everywhere. There were too many bullets, everywhere. It was really heartbreaking.

I briefly lost consciousness. I was with four other people in the car. We first pretended that we were dead, then we fled on foot and hid.  

How did you keep working after an experience like that? What motivates you?

I kept thinking, “Why am I risking my life by going to work in the mountains?” But to me, that was my strong calling from the beginning, because I knew the conditions and had grown up without access to health services.

So I kept going, and worked for five years as medical director for Village Health Works.

What makes me most happy is when I serve patients, and they get better. Work is my passion, to keep going and helping, by all means. That is my passion. That is my calling.

In 2012, you joined Harvard’s first class of master’s in global health delivery students. What did that mean to you?

I was fortunate, more than fortunate, to be part of that program. My mother and father didn’t go to school at all; they had never been in a school.

Even though they didn’t go to school, they knew the value, and they always encouraged me to be the best. To never give up. They did all they could; we had cattle to help pay for school fees and for other things, like books.

When I lost my dad, my mother kept telling me that I needed to succeed.

I’ve always tried to do the best I can. I always want to succeed with high marks and do what it takes to push myself to a greater level. While I was studying at Harvard, I worked hard to succeed. It was a new system and a new environment to me, but I did it. My thesis still is being used as educational material for students in the global health delivery program. I’m invited to present my work each year in the mixed methods research class, and I am always grateful to have the opportunity to share with the students.

Your mother is 87. How does it make her feel, to see you as a doctor now?

She is very happy to see me and my profession. Being a doctor, I am treating her well and I will do all that I can to keep her healthy.

I see her very rarely. In Burundi, there has been renewed political crisis since 2015. More than 500,000 people have fled the country. I wanted to bring her to Maseru (Lesotho’s capital), but she refused. She said: “I have lived long enough, and even if they come and kill me, I won’t leave my home.” It is very touching.

Fortunately, nothing has happened in my village. Many people have been killed in Bujumbura, but in rural villages there is peace. She is still living there. I talk to her at least twice a week.

I’m still hopeful that one day, under a new government, I will go and see her. She is sick, and she needs care, so I am still planning to travel there and see her.

Given your travels and global experience, how many languages do you speak?

Five. My first language is Kirundi, and French was my language of education in primary school up to university. I also speak Kinyarwanda and Swahili. I started to learn English in 2008, when I joined Village Health Works and began working with people from America. I forced myself to learn and use English, which now is my fifth language.

When you’re not working, what do you like to do?

When I happen to have some free time, I like to be in nature, where there are trees. I like to be in a place where there are animals. Being around cows, dogs, birds, and mountains makes me feel happy.

At our family’s home in Burundi, we have a dairy farm, with dogs and people who help take care of the cattle. Sadly, I don’t have animals here in Lesotho. I once wanted to buy a horse but I realized that I wouldn’t have time to feed and take care of it here.

And I’m often in touch with my siblings. Some are in Burundi, but others have fled the country and we haven’t seen each other in a while. We do talk on the phone on weekends.  

How long have you worked for PIH?

Formally, I joined PIH after completing studies at Harvard in 2014. But I had known about PIH and worked through their support since 2008.

During my time with Village Health Works, I frequently visited Inshuti Mu Buzima, as PIH is known in Rwanda, to observe the model of care and implement it in Burundi. I participated in many trainings, meetings, and workshops organized by PIH, and consider myself someone who has been working for PIH for many years.

This year, you became the executive director in Lesotho just as COVID-19 arrived. What has this past year taught you, and how has your team responded to the pandemic?

Initially, there was a lot of false information about COVID-19 spreading on social media and in communities.

So, I created a special team and worked with them to make sure that all COVID-19 infection prevention and control measures were implemented in our workplaces, and that our staff had enough Personal Protective Equipment (PPE), with accurate information to help them continue providing services. But I realized that all of those things were not enough—we needed to provide additional mental health, psychological, and social support to our staff, who were and are experiencing stress and anxiety. We’ve created a staff wellness and peer support program to assist our staff and patients.

I’ve worked hard with my team to write grant proposals to help us get funding to continue our routine services, mitigate the negative impacts of COVID-19 on our health services, and keep supporting the government of Lesotho in building a resilient health system.

My new responsibilities during this COVID-19 pandemic have been challenging, but I always tell myself that I have to do all that it takes to protect my team and our patients, and I have to make positive changes to put PIH at a higher level. I am grateful that all of our staff are healthy today and that we are still providing care to our patients.

*This interview has been condensed and edited.