The answer was that in Burundi, having a clean bill of health has taken on a very particular meaning: unless and until you have paid for your hospital treatment, you simply can't leave, you are in effect a captive.
Marriage has a unique place because it speaks of an absolute faithfulness, a covenant between radically different persons, male and female and so it echoes the absolute covenant of God with his chosen, a covenant between radically different partners.
And when the world is created, it is created in such a way that those eternal objects of God's loving wisdom become actualities - interacting with one another, relating to God in the finite realm.