DRC – not just the Kivus!

This past weekend, I went on a 3-day trip to the field with my senior log assistant and project coordinator. Our destination was Manono, the nearest ‘cité’ to Shamwana and a short 6-hour, 170 km drive away. Our main goal was to explore local purchase opportunities and the ability to use the twice weekly flights from Manono to Goma as a way to get expats out of the project.

So good to get out of the base and it was great to see another corner of the DRC. It also gave me lots to think about and I’ve shared some of these thoughts over the next couple of entries.

Ministry of Health

We started with a short side trip to visit the doctor in charge of the Ministry of Health side of operations in 4 of the 6 health centers we are supporting. This is as high as it gets without going to Lubumbashi so that was interesting. Got a few documents signed, discussed the incentive to be given to the new “Directeur de Nursing” recently posted to Shamwana and picked up a few motorcycle parts that we had lent them during their last visit.

Getting there was fun. A 5-hour driver, crossed a wide river by row boat and then it was a 2 km walk to get to his office. The office is on the same grounds as a large 50-bed Ministry of Health referral hospital and is in the center of a large village. Access by boat is the best option as there are no bridges and it is at least a 2-day drive to the nearest barge.

Before MSF opened in the area, all serious cases from the health centers we support were referred to this hospital. That’s pretty crazy. 5 hours by car or at least 2 days by bicycle meant that most people just wouldn’t bother. In the end, this is the main reason for opening our hospital here in Shamwana.

The most shocking part was the total lack of drugs in this hospital. There weren’t many patients either but, without medicine, why bother coming?! Our small health centers are better stocked then this 50-bed hospital! Is this what will happen in our region when we close our project? We can build the buildings, train the staff and implement as many protocols as we want but who is going to buy the drugs or pay the staff once we’re gone? Definitely showed me that the Congolese government is not ready to take over just yet.

Photo: G.Assenheimer | Ministry of Health hospital

Ghost Town

Before the war, Manono was a pretty happening place. Post office, electricity, trade schools, running water. Big tree-lined boulevards with promenades and nice shops on either side. There was even a section of town with paved streets and huge European houses.

Mining was the mainstay of the economy and, under the Pro-Western government of Mobutu, a handful of foreign companies were busy pulling as many minerals out of the region as fast as they could. With the outbreak of war, all of these companies pulled out and none have returned. Hundreds of individuals now comb the tailings piles in hopes of finding something they can sell in what is now termed “artesian mining”…but there hasn’t been steady work in the mines here for quite a while.

Ruins

When people ask how was Manono, I tell them that it used to be a nice place. There are rusted out cars sitting on blocks in a few of the yards. Beautiful European-style houses are vacant and overgrown. Stores lining the boulevards are boarded up and there really isn’t so much traffic anymore. While there is a lively market, there isn’t really much in terms of shopping and prices are high because everything is either flown in or comes hundreds of kilometers by truck.

Photo: G.Assenheimer | House in ruins

The hydro-electric plant that supplied power to the entire region was build by the Belgians in the 1960s. It survived Independence and stayed operations throughout Mobutu’s regime when so many of the other services were neglected. It wasn’t until 1998 when troops, advancing in their successful coup to overthrow Mobutu, stole the transformers and took them back to Rwanada.

5 years of war followed and the plant is now far from functional. Transmission lines were stolen and sold for their copper. The water channels feeding the power station developed leaks and flooded the buildings. Tin sheets found new homes. Instead of providing power for tens of thousands, the locals now use this relic as a good place to fish.

Photo: G.Assenheimer | DRC mines

I’m still not sure how I feel about the gross exploitation of natural resources in this area. It is true that not much (or any!) of the profits stayed in the DRC. It is also fairly unlikely that there were Congolese living in the fancy European-style houses. But there was work and that has to count for something. Without the mines, there are so few options for employment. There is no electricity. No roads or bridges will get fixed.

Rebuilding?

Following the war, Manono was a hub for NGO activity. A number of organizations started projects and a large MONUC base was opened. Now, as funding to aid agencies continues to be diverted to the Kivus, one by one these NGOs are closing shop and employment opportunities spiral downwards.

In effect, the population is living on the edge. Medical services are extremely limited and food security is low. Rumors of malnutrition are circulating. Roads exist but are barely passable. School teachers are paid $30 US a month. True, there is no longer war in Katanaga…but the population is not out of it just yet.

From my perspective, the trip was a success. The project coordinator caught her flight to Goma and will cross into Rwanda to catch an international flight to Nairobi for a training course. Sound complicated? THAT path is currently the easiest way to get out of the country from Shamwana!!

I was also able to buy simple things like fresh eggs, tomatoes, oranges, garlic and onions, eggplant, papayas, bicycle repair parts, scribblers, engine oil, a few raincoats, and some plastic sheeting. Most of this stuff isn’t available in Shamwana…and, if it is, it is way more expensive. We haven’t had a plane land in Shamwana for over 3 months so it was nice to have some fresh vegetables for the weekend!

Saving Lives 

On the way back, we spent the night at a health center that was outside of MSFs ‘radius’ of support. In late 2008, the NGO that had been supporting this heath center (and many others) suddenly lost its funding and abruptly pulled out of Katanga.

Blamed on the global economic crisis, this departure suddenly left 21 health centers across two regions without adequate medical supplies. The health center where we stayed was no different. They had nothing…and what little was there was expired. No antibiotics. No drugs for simple malaria treatment. Not even a thermometer.

Doctor Grant

We pulled up at 5:30 pm and I was immediately called inside to see a 2-year-old girl with a severe case of malaria. For me, this is one of the hardest parts about working with MSF. Patients and health centers and hospitals are all pretty new for me but I manage ok. It is when I walk into a clinic or hospital as a white expat wearing my MSF T-shirt and it is assumed that I am a doctor that it gets a bit uncomfortable! Hard to explain to a mother with her sick daughter in her arms that I’m (just) the logistician and not actually able to do anything to help…

I am not a doctor. But part of my job as a logistician is to make sure that every car leaves the base with a fully stocked emergency medical kit for cases just like this one. I opened the kit and asked the Ministry of Health nurse if I had what he needed. I did. He was so grateful and, within an hour, an injection had been given, a drip had been setup and the child’s fever was going down.

“Saving Lives and Alleviating Suffering”

She made it through the night but still needed a blood transfusion…so at 6:00 am the next morning we loaded her into our land cruiser and transferred her to the MSF hospital in Shamwana. Both parents were asked to come along in hopes that one of them would be a compatible blood donor for their child….

She got the blood transfusion and she lived.

Malaria is the number 1 killer of children under 5 in Africa….but at least this was one less case for the statisticians!

The incredible part of this whole situation was that there was a Ministry of Health nurse at the health center and he actually knew what to do. Physically, there was a health center. There were patients. The only thing that was missing was the medicine! It is so painful to know that everything else is in place, but without NGOs providing drugs the whole system falls apart!

Photo: G.Assenheimer | Saving Lives

After work last night, I enjoyed a beer, some Pringles and few hours of cards with our team. Small comforts after a long day! So easy to forget that this beer only arrives in Shamwana after a 5-day trip on the back of a bicycle!

No one has a car…if you have money here in Shamwana, you buy a bicycle. These aren’t your normal bikes, either. Heavy duty. You can weld them. They can carry 100 kilos. Not so comfortable but their real value is in the amount of cargo that can be strapped to them.

We’ve given a bicycle to each health center to support patient referrals.

They are using bicycles to transport the bricks that we need for my upcoming construction projects. From the river to the hospital. All 6000 of them…8 at a time.

Its ‘only’ 5-7 days by bicycle to Lubumbashi from Shamwana.

Crazy.

Bikes travel for days as the basic supply lines between villages

My Monday mornings are always a bit stressful.  It is my job to literally wade out into a crowd of local Congolese women and select 10 of them to be our water haulers – our Water Mamas – for the week. 

Inside the compound, we officially start each day with a morning meeting at 8:00 am.  The crowd outside the gate is already gathering by then.  If you were one of these women, you would be there early to stake out your spot.  Likely, you have a baby strapped to your back and have your two oldest daughters waiting in different parts of the line to increase your chances.  This is the only real opportunity you’ll have to earn any money this week so it is a big deal.  Everyone is talking, there is some pushing and an argument breaks out beside you as someone tries to force her way into the line.  A mixture of excitement, hope and desperation can be felt in the air.

Immediately after the morning meeting, it’s time.  Trailing behind my Assistant Log, I head outside the compound and am greeted by over 300 people like you.  Some try to grab the numbers out of my hand.  Others tug on my sleeves, hoping to attract my attention and increase their chances.  But most just wait patiently.  Hoping that maybe this week I might pick them.  Not the favorite part of my job, that’s for sure.

Monday Morning Selection

Directions are shouted in Kiluba and the women from last week grudgingly leave their spot in the line, hopes of being selected again now gone.  I make a relatively futile attempt to kick out the students and pregnant women and to arrange everyone into a couple of lines.  Then, with a number already picked in my head, I start counting. 1, 2, 3, 4, 5…33, 34, 35!  If you’re picked, you get a piece of paper with a number on it and I continue counting as you run down the center of the two lines, cheering like you just won the lottery!

You’ll immediately get your yellow, 20-liter jug and head to the hand pump to start pumping.  20 cents per jug and you’ll probably haul around 75 throughout the week.  Facilitating everything from hand washing stations to wash water for the operating theater to expat showers.

…all of this so you have the chance to be one of the lucky ladies who can transport water for MSF for that week.  Congratulations!

Last week, I spent one afternoon visiting patients with one of the councilors from our Mental Health program. Wow. You don’t answer “that was fun” when teammates ask how it went. The sessions were all in Kiluba, the main dialect here in Shamwana. While the ideas were translated into French for me by the councilor, you don’t need to understand the words to get their meaning. Pretty heavy stuff…

On the surface, Shamwana is all cheerful “Mazungo!” greetings as people busily go about their business. Life is hard but improving and it is easy to forget that real war was here a short 3 years ago. This was one of the first times I had stopped to really look. And when you look, you see the wrinkled hands and dirt under the toenails. You see that the toy is made from an old plastic jug on a string. You notice that her blouse used to be white…but is now gray and so thin its doesn’t conceal much. You realize she doesn’t even have flip-flops…and that life is not as easy as it appears.

The first stop

The lady was a bit older and although she seemed happy to see us, her eyes were tired and she looked tough. Hardened maybe. There was lots of activity in the yard and it seemed like she was running a daycare of sorts. We met outside under a towering mango tree and there were children playing everywhere.

…in 2005 she saw her mother killed by a soldier. It was purposefully done in front of her as a tactic of intimidation. She is still suffering from witnessing such brutality, the loss of her mother and the guilt from not being able to do anything to stop it.

I kept looking at the children. Partly because of the language but also as a distraction. Such a contrast. Rags for clothing and so dirty but totally engrossed in their playtime and completely oblivious to the pain she is in or the reason for our visit.

She had been depressed and was not sleeping at all. She didn’t even have the courage or will to work. She wasn’t really eating. This was MSF’s 7th visit and she has come a long way. Suggesting simple things like thinking about better times, surrounding herself with things she likes (the children!) and sharing her thoughts and feelings with others has helped. She still looks tired and there is a definite sadness in her eyes but she’s sleeping better and has started to go back to her fields. Although I didn’t really understand, she even laughed a few times during the session and I don’t think that happens too often for her.

One boy was busy making a small house of out chunks of wood left over from a recent construction project. He was completely engrossed by his task and there was an element of pride in his work…trying to get it just right. An older boy walked by and pushed over part of his toy house for fun. The smaller boy didn’t do or say anything…he didn’t even look up and just started to rebuild that section. Such is life, I suppose, here in the Congo…

Continuing

The second visit was also to see a woman traumatized by the war. She was forced to flee and saw friends and neighbors killed. She is still unable to sleep because of reoccurring nightmares and is absolutely afraid that the war will come back. This was the councilors fourth visit and already things seemed to be moving in the right direction.

The final stop was the first follow-up visit for a new patient. She told us the story of how her husband was killed. The fighting had already started and they were fleeing. The soldiers shot randomly into the village and one of these stray bullets hit and killed him. Silent tears fell down her cheeks by the end. No translation was needed. We just listened…