That Kindamba Kid

Sometimes my head mechanic Richard will come to discuss a problem with one of the vehicles. When someone talks to me about auto mechanics in English I will often have a vague idea of what’s going on. In French, I haven’t got a clue.

It usually goes something like this:

Richard: Ça semble qu’il y a une trédunction dans le flambusticateur arrière. Je vais enlevé le dénupicateur de droite aujourd’hui pour vérifier le niveau de fluide dans le plounge.

Me: OK.

Richard: Alors je vais te dire ce que je trouve.

Me: Parfait.

(Some hours later.)

Richard: Oui, comme j’avais pensé, le flambusticateur est complètement débranlé. Il doit y avoir une fuite dans le perconstateur.

(So, just how bad is this? Can we fix it this afternoon? Send it back to Brazzaville for a week? Drive it out to the edge of town, set it on fire, and blame it on bandits? Try not to look stupid here.)

Me: Qu’est-ce que tu pense qu’on devrait faire?

Richard: Bon, il faut qu’on le remplace.

(Are we replacing the perconstateur, the plounge, or the flambusticateur? It must be obvious; just go with it.)

Me: Est-ce qu’on a un remplacement dans le stock?

Richard: Naturellement.

Me: Combien de temps ça va prendre ?

Richard : Une demi-heure peut-être.

(Saved again. Everyone needs a good mechanic.)

Since 2007, MSF has been successfully treating patients with HIV/AIDS at Kindamba hospital, a small and very basic rural healthcare facility.

In some cases patients have been pulled from the brink of death to become functioning human beings again, after only a few months of treatment. The transformations can be startling. Not only do the patients benefit, so do their families and communities.

Dr. Ahmed (left) and Dr. Sam (right).

The Kindamba hospital program shows that HIV/AIDS can be treated effectively in rural Africa. It doesn’t take much. The solar-powered lab facilities are basic – only CD4 counts and liver function tests are needed here.

  Dr. Sam talks about HIV treatment (English) – 1.1MB MP3

Dr. Sam talks about HIV treatment (Français) – 1.1MB MP3

Patients take inexpensive, high-quality generic HIV drugs. This is the key – using generic drugs allows MSF to treat more patients.

Shipment of MSF medications from the International Dispensary Association (IDA).

It’s also possible to treat people more effectively with generics. A single generic formulation can combine several different drugs that otherwise would have to be taken separately. This makes it easier for patients to take their medication.

And after MSF leaves, generic drugs remain affordable to governments that are motivated to continue providing treatment to people living with HIV/AIDS. When MSF withdraws from Congo, the Kindamba patients will continue their treatment at the government hospital in Mindouli, about 80km away.

None of this would be possible with expensive, patented HIV medicines. Visit the Campaign for Access to Essential Medicines website to learn why [http://www.accessmed-msf.org].

More than bandages.

Dr. Sam is a Congolese physician who has worked with MSF in Kindamba since 2006. He is a short, round-faced laughing Buddha of a guy, probably one of the warmest people I have ever met in my life. If someone mentions his name, you start feeling better right away. Here he talks about treating HIV/AIDS at Kindamba hospital.

Dr. Sam!

The other day we left our small, remote village of Kindamba for the three-hour trip to an even smaller and more remote village called Vindza. MSF has been supporting a health centre there for the last few years.

It was a beautiful, sunny day. I rode alongside ace driver Jean-Baptiste in the pickup truck, behind a Land Cruiser packed with MSF national staff. The road to Vindza is pretty choppy, and soon nurses Edwige and Clévie were launching their breakfast manioc out the side of the vehicle.

Through the back window I glimpsed the displeased faces of their fellow passengers as we lurched over the lush, rolling hills. I felt relieved to be riding in the pickup.

Driver Jean-Baptiste (or J.B.) is a friendly guy who doesn’t talk much. He can look at a 45-degree wall of mud crisscrossed with deep tire trenches and immediately see the path that will take him to the top.

Car radio / “Seat belts must be worn”

When the car ahead of us hesitated at the base of such a hill, J.B. radioed quick instructions to the less experienced Antoine – “gauche, gauche, gauche.”

In Vindza, crowds of people had arrived at the health centre for MSF day, mostly women and young children. Our staff quickly deployed to weigh babies, give inoculations, and pass out a therapeutic food called BP5, which to me tastes like little blocks of sweetened sawdust. But for malnourished kids it’s just the thing.

In Vindza, villagers listen as the MSF handover is explained.

One of our jobs was to begin transferring the health centre back to the government, and to make an official donation of supplies that would see them through to May. First on the agenda was getting all our paperwork signed and stamped.

I was impressed by the local government official’s complicated signature. First he executes a long, dramatic squiggle, more than enough to satisfy most people. Next come some tiny, precise hieroglyphics along one of the arms of the squiggle. Then some more hieroglyphics, in a different style, near the bottom. He rounds it off with three carefully-spaced horizontal lines. Take that, con men and fraudsters.

Around here, people also like official stamps, and everyone was carrying two or three to apply over their signatures, in different colors. I’m not sure, but I think it was a bit competitive. I wondered if our blurry little MSF stamp was letting down the side.

The signature pages looked elaborate and important when everyone was finally done. At a glance, you might think we had just signed a sweeping peace treaty in Darfur or cancelled the foreign debts of every country in Africa.

After finishing with the drug donations we drank fresh palm wine and ate kola nuts and spicy peppers with the community health committee. The local government official explained to the assembled masses that MSF was leaving, and they seemed to take it in stride. In theory, it means that things are returning to normal. An emergency aid organization shouldn’t run your public health services indefinitely.

Keep cool … medications, that is!

With business taken care of, I sat down with the guys from the health committee for some man talk about hunting. It turns out that you need to go all the way to Brazzaville to get a permit if you want to shoot at elephant or rhinoceros.

But there are plenty of gazelle. Set fire to a few acres of dry grassland and you’re more than likely to flush one out. Recently someone saw a lion take down a sheep, over by the river. Big game thinned out over the last few years, but things have been getting better since the war ended.

Dr. Kevin read my blog when he visited last week and told me I’m writing too much about work. Dr. Ahmed thinks I should be writing more about work: “You have to write about the meetings!”

Lately I read a great book about MSF called “Hope in Hell,” by Dan Bortolotti (Linda: thanks for sending it to us). In it he quotes one nurse as saying: “If you hang out with the Dutch, you know you’re going to have endless meetings.”

In fact the whole Congo-B mission is run by MSF Holland, and here in Kindamba, big boss Leonie is Dutch, so that guarantees us a double dose of meetings.

The worst are the expat meetings on Friday nights, when after crawling to the finish line of another eighty-hour workweek, we have to prop open our bloodshot eyes and re-evaluate the three-month plan by the light of Leonie’s laptop screen. Then we’re allowed to eat dinner.

Come on Leonie, says Ahmed, we already meet about this stuff five times a day. Ahmed and I are getting ready to mutiny on the meetings issue. When nurse Maartje comes back from vacation there will be a secret counsel.

Then there are the general staff meetings on Saturday mornings that go on for hours, as we broil in the sun under our traditional thatch-roof Congolese gazebo. People who just finished night shifts are left with drool running down their faces.

MSF office administrator, Gérard, sporting a Muskoka t-shirt
he picked up in Brazzaville.

And a few times a week we meet with the bureau de staff, who represent our beautiful hardworking Congolese employees, to learn about the various and deplorable ways that we’re violating workers’ rights. Did I mention that the Republic of Congo used to be a socialist state?

Unfortunately, Kindamba head guard, Gotron,
could not be at the 2001 NGFL Cheerleading Championships
due to prior commitments, but he did get the T-shirt.

I’m not going to write much more on this topic. Come on Ahmed, who wants to read about meetings?

Also I should avoid stereotyping my colleagues. A little further on, Hope in Hell quotes an American logistician irritated by MSF’s internal squabbling: “ ‘The French are this, the Dutch are that, the Belgians are this.’ Who gives a shit?” Well put my friend.

Here are some of my neighbours playing a familiar carnival game. For 75 francs (15 cents) a toss, you can try to throw a metal ring around one of several tantalizing prizes – including tinned meat, tomato sauce, cooking oil, and a bottle of beer. The most desirable prizes are placed furthest from the player.

TV hasn’t really made it to Kindamba yet, so this is a major spectator sport. Rings are not flung haphazardly. Before a toss there is a lot of discussion, consultation, sizing up of the different prizes and the probability of scoring them.

When I arrived to watch, players and audience were momentarily distracted. I don’t speak Lari, but the theme of the conversation seemed to be “Hey, the white guy’s here.”

I figured that all the extra attention would spoil my concentration, so I declined to play. Maybe next week.

Antoine

I walked over to a group of staff who were hanging around the base on Sunday afternoon and asked who wanted to be an Internet star. Antoine, one of our drivers, eagerly volunteered.

Antoine talks about his experience driving for MSF in Kindamba. [MP3 : 593kb]

MSF Kindamba driver Antoine.

Marcus

Marcus is my storekeeper. I met up with him while he was walking to the hospital on Sunday afternoon. He was taking his little baby Iris to be breastfed by her mother, Faudrine, who works as a nurse with MSF.

Iris took one look at me and flipped out. Maybe she’s never seen a white guy before. But she soon came around, and after a while she let me hold her for about 15 seconds.

Here is Marcus talking about his baby.
[MP3 : 622kb]

MSF Kindamba storekeeper, Marcus and his daughter Iris.

I was in Brazzaville for a few days of rest, relaxation, and figuring out why one of our suppliers has been grossly overcharging us for food. The prices on the shelf didn’t match the ones on our bill.

In the end the Yemeni shopkeeper was friendly and reasonable about the whole thing, and he readily refunded the amount that we were overcharged. We all agreed to blame a careless former employee and to continue doing business together.

Some people said I got off lucky. Apparently persistent demands for accountability often end with a large and well-armed chap escorting you off the premises.

Later I visited Talangai night market with Cécile (MSF super scientist). This place could work really well in a Cronenberg movie. It’s quite dark, with tightly packed stalls lit only by little kerosene lamps. The main offerings are alien-looking fish in various stages of asphyxiation, and exotic meats.

Talangai night market squints in the harsh glare of my flash.

By the time we got there most of the croccodile and snake had already been sold, but there was plenty of turtle: live and dead; whole and in parts; giant riding turtles and cute little guys like the one that your third grade class kept in an aquarium, until someone forgot to feed it over Christmas break and you came back in January to a bad smell and an empty spot where the aquarium used to be.

Could be turtle at the Talangai night market.

One stall had big chunks of raw gazelle meat spread out on a bloody table. Sales were morbidly supervised by the gazelle’s own recently severed head, as proof of authenticity and freshness.

Cécile stopped to ask one vendor how you might go about cooking a 40-pound turtle. For a while we discussed turtle recipes and laughed together over the absurd prices proposed for the beast. Soon we attracted an entourage of admiring young pickpockets, who distracted us from our shopping.

I kept an eye out for smoked monkey, but apparently that goes pretty fast. Talangai’s customers are a discerning lot. “When there’s an Ebola outbreak upcountry you can’t sell monkey here, even at 500 francs ($1) a kilo,” MSF driver Euloge informed us.

(Spread by monkeys, Ebola is the famously incurable hemorrhagic fever that, in extreme cases, causes your internal organs to liquify and leak out of you.)

So that’s a good thing, I guess, and a triumph for free markets. Call me overly cautious, but I’m going to stay off the monkey meat. Their little faces remind me of this kid I knew in third grade.

We’re definitely having crocodile steaks next time I’m in town though. Seeing as the croccodile could be hunting you at the same time that you’re hunting it, I say fair dinkum.

Equal parts bizarre and appalling, “Mammon moppet” brand
children’s
clothing at Poto-poto market, Brazzaville.

Yesterday we handed over the outpatient department at Kindamba hospital to the Congolese Ministry of Health. This marked the first phase of MSF’s withdrawal from the Republic of Congo, which will be complete on May 15. Over the next two and a half months we will transfer the rest of the hospital departments and six rural health posts back to the government.

It was a small informal ceremony with our own Dr. Ahmed and Nurse Maartje, Nurse Opportune from the health ministry, and three members of the community health committee that will oversee the hospital after we leave.

Together we verified MSF’s donations, checking off items on the inventory list – cloxacillin, artesunate, multivitamins, bleach, buckets, pens, weigh scales and examination tables. I held up thousand-tablet bottles of paracetamol like rare art objects at auction, for everyone to see.

Nurse Opportune presides over the bounty.

I was satisfied to observe the members of the community health committee taking their jobs seriously, even asking to inspect and count some of the donation items. At one point, the head of the committee rightly objected to the mangled state of one of the hand towels we were leaving behind, so we fetched a new one.

We carefully arranged the donations on an examination table as we counted them. By the end the table looked like the prize set on a humanitarian aid edition of Wheel of Fortune. “Everything you need to run your own outpatient department in rural Africa! Antibiotics, anti-parasitics, anti-malarials and anti-inflamatories! Seven hundred pairs of latex gloves and three different brooooooms!”

Discardit packs.

The mood at the handover was upbeat and hopeful. But without outside support, Kindamba Hospital is going to have a hard time providing a high level of care after MSF leaves.

One of the biggest problems lies in getting doctors to come and work in Kindamba.

Why? For starters, the town is remote and the road can be reduced to a muddy soup during the rainy season. Getting here takes us 7-10 hours by Land Cruiser, depending on the weather.

For everyone else, traveling in the back of the transport trucks that run irregularly between Kindamba and Brazzaville, travel time could be as much as a week. That’s how long it can take to walk if your vehicle breaks down en route.

The road to Kindamba is dotted with the picked-over skeletons of trucks written off by their owners, and the campfires of poor and unlucky travelers. Walking for days under the hot sun with your luggage balanced on your head can be gruelling; sometimes it can be fatal.

Sun-bleached bones of a pickup truck.

Even if you can convince a doctor to leave behind the comforts of Brazzaville and venture off into la brousse, money remains the big issue.

Ministry of Health salaries for doctors start around 150,000 francs ($300) per month. Of course a doctor can supplement this income through private practice, but only where there are patients who can afford to pay high fees.

Here in Kindamba, the 500 francs ($1) that the Ministry is proposing to charge for basic treatment is going to be a big stretch for a lot of families. Some people will do without health care or wait until they are extremely ill before seeking treatment. Paying private fees would be unimaginable for most of them.

So the Ministry of Health may assign doctors to Kindamba Hospital, but they simply won’t come here. And who can blame them? How could a Brazzaville doctor tell his family that he’s going off into the bush to treat patients in a remote village, that he’ll only be back to visit a few times a year, and that the entire family’s standard of living will be slashed? Would you do it?

This may look like an ordinary, harmless clothesline draped with drying laundry. In fact it’s a breeding ground.

The female tumbu fly loves nothing more than laying her eggs in wet laundry. It’s the tumbu fly equivalent of a safe suburban neighborhood with good schools for the kids.

The children in question are tumbu fly larvae, and they like to spend their formative days nestled cozily in your towels, trousers and underpants.

Drying laundry.

These little fly kids are very sensitive to heat and vibration. When you slip on your sun-dried drawers, they get to work right away, burrowing painlessly under your skin in less than a minute.

This soon produces a prickly, itchy boil, inside of which the developing tumbu fly incubates for up to 12 days. The fly breathes through its tiny rear end, which you can see at the head of the boil, if you look very closely.

If you’re patient, your foster fly child will eventually grow up and want to get a place of its own. One day it will fall out of the boil and get on with its brief, annoying life.

But if you’re impatient, as most people with fly larvae living inside them would naturally be, you can turf the little freeloader out right away.

Simply spread vaseline on the boil, which cuts off the fly’s oxygen supply. Small indignant bubbles will appear, and then the suffocating larva will start to work its way out. You can speed its departure with some helpful squeezing. (Though if you don’t squeeze properly, you can develop a big abscess and end up under the knife of Dr. Ahmed or Dr. Sam).

An ounce of prevention is worth a pound of cure, and the good news is that you can prevent this whole nasty business by vigorously ironing both sides of every piece of cloth that comes near your body. Socks, sarongs, skivvies, the works. The hot iron cooks the little fellas where they lie.

Here in Kindamba, we have Mama Thérèse and her well-toned ironing arm to thank for the fact that we are not covered in itchy, prickly pustules. Matondo!

(Written with help from the 21st terrifying edition of Manson’s Tropical Diseases — 2000 pages of raw horror that will send you bolting for the next flight to some polar ice cube where you can’t get whatever that is on page 519)