Back from the field

I left as planned three weeks ago to help set up the program to provide primary and secondary health care for the displaced families in the area of Lubero. We set up in an existing health center, working with their staff and recruiting others to accommodate the 50,000 displaced people, along with their local population.

Our small team stayed at the catholic mission in Lubero, where I had stayed 3 years ago for a weekend. It was great to see Father Robert again, and some of the brothers who are still there. Catholic missions in Africa often provide the services of a guest house for travellers, since hotels in the bush are inexistent. We rented 5 bedrooms, plus another one to use as an office.

The start-up went surprisingly well. We were able to negotiate with the Ministry of Public Health (with a bit of difficulty), our entry into the health center. Handicap International loaned us a small warehouse for our material. And the staff of the Kasalala health center welcomed us with open arms. We defined our staff needs to complement the 18 people already working there the first day, and developed the recruiting flyers. There were 2 days of collecting candidatures and the pre-selection. Recruiting interviews to hire 4 nurses, 1 hygienist, 2 drivers, 3 guards, 1 logistician and 1 administrator were done in a single day. And we started working in the health center the next day. As always here in Congo, we were able to find really good people.

During my stay in Lubero, it came to our attention that a cholera outbreak had begun farther north on the Congo/Uganda border at Kasindi. Cholera is a disease which propagates very rapidly, and it is deadly if not treated quickly. Basically, the cholera bacterium causes the body to eliminate all its water via constant defecation and vomiting – one dies from extreme dehydration. Treatment of cholera consists of pumping liquid back into the body as quickly as it is eliminated, until the bacterium dies on its own. At the same time, the patients must be isolated from the rest of the population, because the body wastes are extremely contaminating – they must be treated before disposal to avoid infection of others.

So once I had helped to get the Lubero operation going, I headed northeast to Kasindi to help set up the cholera treatment center. At Kasindi, a doctor, a logistician and a driver had arrived 2 days before me. The treatment center was already taking shape. I went to a larger town 2 hours away with the driver to rent 2 cars (1 with a driver) for the program, as well as to pay the guards at a warehouse we have there (prepositioning emergency stock, including the product we use to treat cholera!). Once we had the cars, we loaded up as much of the cholera drugs that we could hold and returned to Kasindi. Once again we defined our needs and started the recruiting process, this time even quicker than the last, due to the nature of the beast we were fighting. I spent a couple of days, finding a base (we basically took over a tiny hotel), making purchases for the treatment center, speaking with Ugandan health officials (who were VERY happy to see us there so that the epidemy would not spill over into their country), finding a place for the staff to eat, and posting recruiting flyers. Once again, we were able to find great people.

My trip was supposed to be 4 days when I left. It turned out to be 2 weeks - my jeans weighed about twice what they do when they are clean. I returned on Wednesday evening the 18th of March, to find an astounding number of mail messages to respond to. And Friday and Saturday were wholly dedicated to the MSF field associative debates, where we bring in employees from each of the sites for the 4 sections of MSF in the region (France, Holland, Spain and Belgium), to discuss issues pertinent to our operations. Needless to say, the trip didn’t help to alleviate my work overload – I have just caught up with the backlog of mails. But I was really happy to help start up these programs. In Lubero, we are working well in the health center, and have started up some mobile clinics, treating displaced people in other villages. And in Kasindi, the cholera outbreak has been contained, and we will soon finish our intervention there.

But I can’t do everything. I felt so overwhelmed by the workload that I considered resigning from my post a couple of times lately, so that someone more capable could take over. I spoke this over with our medical coordinator, who told me that she had considered the same thing at about the same time. So we both decided to stick in out.

Our proposal for staff salary increases and job function scale revisions are still on hold in Paris. The staff are impatient, and Paris is blocking; due to the instability of the economy, they are rightly nervous about the amount of contributions we will receive during the coming year. A commission of 4 people will be coming in mid-April for 3 weeks to work with us on a final decision on these and some other pressing human resources issues. That’s a relief, but it will be an intense period for me.

So I am leaving Saturday the 4th of April for a week-long break BEFORE they arrive. I will be going to Lamu, an archipelago off the coast of Kenya, up near Somalia. It seems to be more expensive than Zanzibar, but it’s good to change destinations. And after 8 months of 12-13 hours a day 7 days a week, and 4 months after my last break, I really need a rest.

Life in Congo

Here is a recitation of one of my collegues which I just translated from French. Unfortunately it is an accurate description of what life here is like.

« The displaced »
between wandering and aberration

The armed forces which we won’t identify (even if here they are freely installed within the civil population, named and designated), include at least 6 different groups fighting between each other. They fight under title of alliance, certain groups in coalition against “one” other, decreed as the official enemy of the moment, of the regular national army. That’s been the principle… for more that 12 years. And during the last 10 years 5,700,000 Congolese have died, mainly civilians… and the majority in the Kivu region.

Whatever the military strategy, the scene is identical. The soldiers encircle a zone where life plays out between towns and villages, work in the fields, small businesses of selling fruit… The targeted zone which fills up little by little with soldiers is surrounded by scrub forest in which the ambivalence is completely between danger and protection.

Then starts the sound of bullets, the robberies, the burning of houses and all the rest. The soldiers, gifted with the magical power of arms, take possession of everything. The territory is now their new camp. The inhabitants flee, taking with them whatever they can. And they walk.

They walk in groups which will lose a member from time to time – men, women, and children of whatever age. They walk for days without end on rocky and washed-out paths made of red earth; the babies snuggled up to their mother’s bodies, the bundles of simple cloth holding a few pots, a bit of “manioc” for survival. They know that they have lost everything, even if they return in a few weeks.

They walk in files, small children of 5 or 6 years old often carrying three times their weight on their heads. They are all exhausted, after 30, 40 and sometimes 100 kilometres or more. So the groups break off into smaller groups more and more scattered.

They walk, and they are tempted by the scrub forest to sleep a bit. The forest - dense, very attractive, very green with large banana leaves - seems the perfect shelter… but perfect for everyone!, militias and other undesirable partners included.

They walk and sometimes get lost, wandering aimlessly.

At 35 years old, F.Muk’s husband was killed and their house occupied by soldiers. Obliged under threat, she took to the road one night towards what she considered a safe place. Her children are young….., she is intercepted on the path by a few soldiers with undisguised desires…, she begs her children to continue walking under the guidance of the oldest who is 13 years old…..

Afterwards, she searched a long time for her children, finding them two days later but with one missing! The despair is immense when I meet with her several times. Hazard and solidarity joined forces allowing her to find the last child 20 days later.

R. and L. are both nurses and have 4 children. Soldiers arrived at their house, firing haphazardly without aiming at anything. It was an expressive announcement of what was to come. After being beaten, R. resisted no longer – his brother had been shot a few months before. This couple also took to the road. The soldiers had taken their oldest child of 11 years old as hostage, to carry their plunder. R. and L. had to save the other children. They also walked the 150 kilometres that separated them from the rest of their family.

Stories like this can be told without end… the list is long and the recitals are extended. We’ll stop here. Just be aware the even those who “walk” know that one day they can also become one of the unimaginable number of 5,700,000 deaths in Congo.

Maryvonne,
Psychiatriste in Kivu
February 2009

It's me again. I should be leaving Goma for Lubero next Saturday to help set up a new operation in that area, to provide primary health care for a newly displaced population of around 50,000 people in the same situation as those who's tale is told above. Our resources are becoming pretty extended right now, mainaining our existing programs and at the same time trying to alleviate the suffering of the new victims of this chronic situation. Fortunately, we have very good people working with us who are dedicated to this work.

Our work has become more complicated recently by the fact that bandits are now targeting aid worker's cars, forcefully taking money, phones, and pharmaceutics. Having a Kalichnikov pointed at you, along with verbal threats that you can't understand, is not a pleasant experience. The number of roads available is limited already. This new development hinders us even more in where we can go and how we can react.