From Bunia

The closure ceremony was a great success – 350 people, traditional folk musicians (with the real one metre long Vuvuzelas, not the little ones we saw at the televised world cup matches), and the opportunity to remind the community of MSFs new role here in Bunia.

The hospital Bon Marché exists no more – except for the Women’s Health service, which will be taken over by a local association in the coming weeks. So we will still be in Bunia to ensure that this new Women’s Health / Sexual Violence service gets up and running. We will also continue the process of skill transfer and capacity building at the hospital and 7 health centres, to ensure that the transfer of pediatric services that has already taken place is fully successful – that the quality is maintained, and that the health facilities can meet the population’s pediatric health needs autonomously. And the same for HIV – we will continue our support to the hospital to try to ensure that quality of care and availability of medications continues after our departure.

It’s a challenge to guide a team through this stage – with 100 people laid off, and all our work (as we knew it) at an end, we are all liable to feel a little lost and deflated. So we’ve made the effort to elaborate our vision for the coming months, and to generate objectives that we review periodically. It’s an interesting transition – the move from traditional MSF style hi-tech substitution healthcare, to fully integrated, resource-limited, sustainable healthcare. We just have to keep telling ourselves that this change represents an interesting opportunity for creative collaborative working – and is not just a half-hearted attempt to delay our final adieu to Bunia.

I am optimistic now. At times, with threats of strikes and the total absence of medications I thought that we would never get there. Yet now we are already there – the quality of care is more than acceptable, and a huge number of obstacles have been overcome. Now it is just a question of figuring out how to stay at this level in the years to come!

I suppose the last few weeks have turned out more or less as I had imagined. As we have ceased to admit new patients or transfers (all are now managed at the general hospital), the wards have become emptier, the staff more melancholy, and the atmosphere a little strained. Project closures are not reputed to be easy – one undertakes this sort of work expecting to be treating patients, yet at this final stage the goal is to avoid treating patients. This can obviously be demoralising, and I have found that I have spent much of the last few weeks chatting with taciturn staff reminding them of all the good things they have done here.

For my own part, it does feel sad to be closing down a hospital that has offered hope to so many over the years, that has been one of the few neutral facilities that has bound the different ethnic groups together. I am also conscious that I have hardly worked here, having arrived just 4 months ago – and it feels a little rich to be giving the closure speech for a project which I only know from the testimony of others.

In these last weeks we have to keep going, to maintain a longer term perspective on the value that a well-conducted transfer can have on the community over the coming years – and not focus on the fact that Bon Marché hospital now has just 2 patients. And we must use the closure ceremony to celebrate with the community the successes of Bon Marche; but also to remind ourselves that the closure is a fine thing, because it reflects a collective confidence that the war is in the past now.