DRC – not just the Kivus!

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…

The roosters start at about 4:30 am and are joined by a chorus of wailing babies at daybreak. A car roars to life in the early morning, as our teams get ready to head out. The quiet “flip-flop” of an expat’s sandals can be heard outside my door as an early riser heads to the latrine.

Quiet conversations between the water Mama’s also start early, as they are busy pumping and filling 20-liter jugs at the hand pump in the compound. They will be back and forth many times throughout the day, balancing these heavy jugs on their heads and delivering water to all of the distribution points in the project. The dull thump-thump-thump of manioc being beaten into a fine powder can always be heard. Recently, the swishing and crunching of a peanut de-shelling apparatus starts early and goes on all day.

Each Sunday, the village is filled with song and the deep beat from dozens of drums as the various congregations meet for church.

Mating season for goats and the guinea fowl was especially noisy.

Funeral processions involve the combined chorus of dozens of people chanting and singing and wailing, as mourners progress down the main street and out of town.

Ceremonies from traditional healers or “witch doctors” can last more than a full day and undoubtedly involve chanting and screaming as they chase the evil sprits away. One of our neighbors practices this type of medicine and must be good as he has lots of clients and is often busy well into the night.

As the sun sets, things slow down but don’t really stop. Some nights, the village ‘cinema’ blares out the sounds to a Congolese movie for everyone to hear. There is a sort of bar not too far away and the loud chatter of those who’ve had a bit too much to drink floats over our fence.

The MSF generator shuts down at 9:00 pm and the hum of Concern’s generator dies out at 10. Sometimes an expat’s music or the movie from a laptop can be heard through the tukul walls. The scratching of rats in my roof will often wake me in the middle of the night.

The guards quietly make their rounds.

The crickets are suddenly very loud.

…but it is never completely quiet.

There is always a flurry of activity when the outreach team is preparing to head out. Someone is busy collecting vaccines from the refrigerator and putting them into a small cold box loaded with ice packs. Someone else is packing folding camp beds, mosquito nets and cooking pots into the car as the driver does his daily checks and fires up his Land cruiser. Another member is busy signing out the satellite phone and getting MSF vests for the team. Last minute instructions are quickly passed to those staying in the base and off they go.

Our Setup

Outreach is a major component of our project here in Shamwana, as MSF supports a network of five rural health centers where the Ministry of Health (MoH) is providing basic health care to the population. While these clinics are operated and staffed by the Ministry of Health, MSF provides support in the form of free medicine and technical support. MSF also provides a ‘prime’ or monthly bonus to all MoH staff to ensure that all of these health providers receive a fair wage.

Although each health center is a bit different, they all have an outpatient department and a maternity. Staffed by a registrar, pharmacist, consultation nurse, mid-wife and a cleaner, they provide frontline care in a classic primary health care setting. Supplies are limited, the clinics are absolutely isolated and staff experience varies. All serious or complicated cases are referred to the MSF hospital here in Shamwana and, as crazy as it may seem, it is not uncommon for someone to ride a bicycle through the night to inform MSF of an emergency in a health center.

The Outreach Team

The MSF Outreach team consists mostly of national staff and is made up of 2 nurses, 2 community mobilizers, a health educator and a mid-wife. Supervised by a dynamic Expat nurse (also Canadian!), they enforce MSF protocols, give training sessions, raise awareness and, in general, monitor and supervise the operations in all the health centers. Spending approximately 4 days a week in the field, they also help out with consultations, vaccinations for newborns and reporting.

The relationship between MSF and the Ministry of Health is delicate and just maintaining this dialogue is a never-ending struggle. Here in Shamwana, the success of the project largely depends on the MoH’s ability to take over from MSF so there is a huge emphasis on capacity building within this existing Congolese system.

This afternoon, the team just came back from 3 days in Kyango where we are running a bi-weekly mobile clinic to see if the needs are high enough to justify the support of the MoH clinic in the area. They saw over 200 patients and brought 3 serious cases back with them for further treatment in the hospital. Tomorrow, they are off in the other direction to supervise the activities in one of the standing clinics and to collect their monthly medical order. With 5 different centers to support, there is always more then enough work to keep them moving!

Photo: G Assenheimer. MSF outreach team

A comment posted to one of my entries asked why I choose MSF and what brought me to where I am now. Its not the first time I’ve been asked this question and, in reality, it’s a fair question. I left behind a pretty comfortable life. Good job, amazing girl, hot showers. My brother had a baby and I became an uncle for the first time. My sister is building a new house a mile from where we grew up. Wedding planning and ring shopping are all going on without me. These are just some of the things that I’ve left behind for MSF.

So… why?

Essentially, because I can. I have a family that supports me and a fiancée who truly believes in me in this environment. I have the unusual combination of technical ability, personal drive, flexibility and compassion that make me good at it. I am blessed to have come from a family, a country and overall circumstances that allowed me to follow a dream instead of struggle to survive.

I also like the adventure and relish the opportunity to learn on so many levels (about management, cultures, geo-political issues, myself, the world of relief work). Finally, while I had done some reading on development and relief, I truly believe that the best way to learn is simply to GO. With my skill set, personality, support and a strong desire to help those who are truly in need, the question really became how could I not…

More Specifically

There are 2 events that really specifically helped to shape this desire.

The first was watching the aftermath of the 2005 earthquake in Pakistan. All the news channels were reporting that relief workers were walking for hours – sometimes days – to bring urgently needed supplies and medical care to remote villages. The needs were great, the challenges were enormous and I thought to myself, “I can do that…I can totally do that!”

The second was reading “Another Day in Paradise” by Carol Bergman (2003). This is a book of short stories about humanitarians working in the field on a variety of projects from disaster relief to war zones to feeding centers. I read the book twice and still remember feeling totally inspired by what these people were actually doing.

Naturally MSF

I had been a donor to MSF for a few years and the more I learned about the organization, the more I came to admire what they did and where they worked and how they did it. I was simply fascinated by ‘these people’ who were doing such great things in remote corners of the world largely forgotten by our western media.

…and here I am. Helping those truly in need, directly supporting a great organization and absolutely living a dream.

Ahh Sunday…my day off and a well earned rest. Sleeping in, making real coffee, reading a bit, exploring Shamwana itself and the luxury of a lukewarm mid-day shower. There is usually time to make and enjoy a nice meal for dinner, to catch up on emails and, of course, my weekly ‘date’ over Skype with my fiancée.

Sorry for the slight lapse of entries over the past month! I just got back from a 2-week vacation in Kenya… a bit of time on my own to rest and recuperate and then I met my parents for an 8-day safari through four of Kenya’s famous national parks and game reserves. It was a wonderful vacation and a great break and I returned back to the project energized and ready for part two.

Getting Out

Getting to my vacation was another story! Right now, the mission is in the middle of a transportation crisis. Largely due to funding cuts brought on by the global recession, our flight provider suddenly cancelled all flights to Shamwana and pulled their plane from Katanga. While this has far reaching impacts for our operations, it immediately meant that I had to get to Lubumbashi by car. It couldn’t have happened at a worse time as the rainy season is in full swing and the roads are quickly deteriorating!

…and that is exactly when I realized just how far in the bush I am living. Instead of the relaxing 1.5-hour flight, it was a gruelling 3-day, 32.5-hour, 600 kilometre drive. We got stuck 4 times and averaged 20 km/hr. In places, the ‘road’ is nothing more than a wide footpath. This was a mind-blowing realization of how remote and isolated we are in Shamwana.

Photo: G. Assenheimer | Going up.

Photo: G. Assenheimer | Helping out.

During the dry season, I’ve heard that you can make the trip in 2 days. On the other end, a big truck carrying supplies for the project, plagued by breakdowns and constantly getting stuck, took 6 WEEKS to arrive. Crazy. In the DRC, they even have a verb for “getting stuck in the mud” and our cars are constantly “embourber” in this “saison d’embourbements”.

What is even more amazing is that the first logistician here in Shamwana actually built the runway. He didn’t have a satellite Internet connection and definitely wasn’t receiving a weekly supply of fresh vegetables. And that isn’t some story from the early 1990s… MSF opened Shamwana in 2006. Incredible and hats off to the team who started this project from the ground up.

While we sort out a more reliable solution to our transportation problems, I’m back in the project and have no plans to leave any time soon!

Post-Conflict

Just what does Post-Conflict mean? For me, it sometimes looks and feels much more like international development as there isn’t the same sense of urgency you might find in conflict zones. The ‘just do it’ of an emergency is replaced by budget constraints and planning and proper paperwork. The problems and contextual issues are no longer so obvious and I have to go looking to find them.

Sometimes it also feels a bit more like a job and I feel a bit less like a humanitarian in action. I can spend entire days sorting out overtime hours or writing monthly reports or counting pills and this certainly doesn’t feel like savings lives or alleviating suffering, as in the MSF mandate. It is even possible to go days without leaving the compound or actually seeing any patients or feeling a sense of urgency in what we do.

However, it is all so relevant. Without MSF, the health care in the area would be very limited. No surgery. No patient transfers. No blood transfusions. No free medicine. No testing.  No treatment.  And the population really has nothing. They survive in grass huts on subsistence agriculture. The mosquito net distributed by MSF is one of very few possessions. So many more people would die if MSF was not working here.  Post-conflict medical support is critical to ease the continued vulnerability of the population, to enhance their productivity and facilitate the rebuilding process.

Post-conflict work seems to find its way into the gray zone between international development and humanitarian relief work. It may not catch as many headlines but it is a big part of MSF and plays a vital and often forget role in international assistance. It is also what I am experiencing for the first time here in Shamwana.

Waiting for the dry season

Looking Deeper

On the surface, the villages look peaceful and I’m greeted by big Jambo’s wherever I go. Children are always waving and yelling “Mazungu! Mazungu!” as we drive by with big smiles on their faces. Poverty is widespread and people are living well below the dollar-a-day poverty line…but fields have been planted and markets are starting up again. New water pumps are in use and schools have been rebuilt. Things are getting better and it all seems so normal.

However, as I start to look a bit deeper, I’m getting a better picture. Here are a few incidents that have shed light on this issue.

…our mental health program is still finding new cases of people who, even after 2 years of peace, are still suffering from the effects of war. These are people who have witnessed or experienced brutality or rape, people who have had family members killed, people who fled because of fighting and people who have watched as their house and all of their possessions go up in flame.

…I met the family of my water and sanitation assistant. They used to have a big brick house and you can still see the old foundation in their yard. They now live in grass huts. They fled the first time in 1999 in the face of advancing rebel groups as part of the bigger international war that eventually overthrew the government. They returned in 2002 only to flee again in 2004 during the regional instability of the Congolese Army vs. Mai-Mai battles. They returned again in 2006 and are starting to rebuild. Bricks were made during the past dry season for a new house and they will start building once the current rainy season is over. For now, they are tending their fields and surviving in their straw huts.

New and Old

…my construction assistant pointed out a few spots in one of the Ministry of Health clinics where he had patched bullet holes.

…I can still see the charred marks on some brick buildings where the thatch roofs were torched. The people have moved back in but the doors and windows are largely boarded over and the cracks have been filled.

Burnt House

I am currently working in the classic MSF post-conflict project. The history of conflict and war in the DRC is long, complex, and brutal and, as you can tell from the events still making the news, not yet over. The period between 1996 and 2003 in the DRC marks the bloodiest conflict in history since World War II with almost 4 million dead. Although I’m not going to get into details or pretend to understand the complexities of this conflict, I do want to share my thoughts on just what “Post-Conflict” means to me and to my current context.

Conflict in Katanga

While Katanga was less affected than the Kivu’s by this conflict, advancing rebel groups supported by the Rwanda army displaced thousands in the area. In response, the Congolese government armed village militias and these so-called Mai-Mai groups emerged as small groups dedicated to the protection of the population. The Mai-Mai was not a consolidated rebel group and mainly consisted of small pockets of resistance within a network of warlords and chiefs. As such, the Mai-Mai groups were not included in the Peace Agreements of 2003 and large areas of Katanga were left under their control. In principle, they were there for the protection of civilians. In reality, they were known undisciplined, abusive and ferocious fighters and the simple mention of Mai-Mai could empty villages.

In 2005, military action by the Congolese Army took place to remove the Mai-Mai from these areas and this led to heavy population displacement in much of the Katanga province (up to 400,000 people fled by the end of 2006!). After some time, one of the main Mai-Mai chiefs surrendered and, as the domination of the Mai-Mai in the area decreased, these Internally Displaced People (IDPs) started to return to their destroyed villages.

MSF opened the Shamwana Project in May of 2006 at the centre of one of these Mai-Mai controlled areas. At the time, there was really nothing here. Food was scarce and had to be shared with military. Villages were completed destroyed and people were living in grass huts and crowded camps. Water was taken from dirty streams and sanitation was poor. There was no health care and the existing ministry health centres were in bad shape.

Since then, things have started to get better and villages are starting to rebuild. While life has started again, the needs are absolutely huge, especially in the area of healthcare but also education, roads and food security.

When I first arrived in Shamwana, with its dirt street and thatch roofs, I honestly thought that if there was a place in the world that wouldn’t feel the effects of the global economic crisis, this was it.   How wrong I was…

Due to its immense mineral wealth, the Katanga province where I’m working is the richest of the DRC… a somewhat relative statement, of course.  Copper, zinc, diamonds, manganese, gold and silver have historically been exploited by various foreign interests and have been the basis behind more than one war.  Coltan, an essential component found in computers and cell phones, has become a new source of profit (and conflict!) as it is estimated that 75% of the world’s reserves of this increasingly valuable mineral are found in Katanga.

As nations worldwide slide into this global economic crisis and prepare massive economic bailout packages to save their economies, stories of friends losing jobs and retirement savings being decimated surface in emails from home and make it all seem so much more real.

The impacts out here in the bush are no less drastic.  The global commodity markets have also dropped and practically all of the mining companies in the area have reduced their operations to a bare minimum.  We hear stories of an estimated 200,000 workers being fired in this province alone since September.  That’s huge.  It is also directly linked to security and there were reports of an increase in random violence and robberies in Lubumbashi over the holidays.

Closer to home

When I arrived in December, the 737 from Nairobi to Lubumbashi was practically empty.  This was shocking to my colleagues as in the past it has been filled with Chinese businessmen coming to Katanga to check on their mining operations and it was difficult to find a seat at all.

Funding for internal development and humanitarian relief is also expected to drop drastically with this downturn in the economy.  This is a huge concern for MSF as we rely largely on private funds and I wonder to what extent this will affect our programs here and across the globe.

Many NGOs are facing similar problems and when asked to cut programs in the DRC, they opt to focus their energies – and funds – in the Kivus where you get ‘more bang for your buck’.  While I absolutely agree that the needs in the Eastern DRC far surpass what I see here, it is hard to imagine that the Katanga programs of 2008 are simply no longer needed in 2009.  The sad reality is that this isn’t just the bottom line we’re talking about… this is the lives and livelihoods of the people I see everyday.

Clément

Clément is the new driver I hired this week.  Of the 34 applications I received for my one vacant Driver position, he was one of the 6 who got the chance for an interview and to do a practical test. He started driving 4 years ago with a local NGO, spent a few months working with Caritas and his last 2 years with Anvil Mining.  Each change was not but choice but necessity.  First, both NGOs closed their projects, putting him out of work each time.  Finally, as Anvil mining suspends operations until commodity prices recover, he once again found himself out of work.

This round of interviews was really successful as all of the 6 applicants could actually drive and I had the luxury of including things like attitude and knowledge of land cruisers in my selection process.  Just four months ago, we hired 2 drivers and the story was completely different.  It was a struggle to find someone who had actually driven before and some of the applicants were so bad that they were forced to stop their practical tests before they even left the compound!

The project teams can now breath a bit easier as they travel from site to site…and unexpected silver lining from this unexpected economic crisis.