This is the end

April 27th, 2008 by jakew

It’s done. The boxes full of satellite phones, action DVDs and long-expired medications have been packed and shipped, the confidential files burned, and the MSF logos painted over. Kindamba project is no more.

On Saturday we handed the keys over to Global Outreach Mission Congo (Mission GO), who will continue running the Kindamba hospital, albeit on a smaller scale than MSF.

At the end of an impossibly hectic final week, I gave Mission GO’s director, Dr. Joe, a midnight tour of the base by flashlight. Here’s the generator; that spliced electrical cable held together with surgical tape runs to the garage, this one goes to the house and offices. Here’s what to do when the system overloads, there’s the fire extinguisher, good luck.   

Michaelle Edgard

Michaelle and Edgard pass out on the way back to Kindamba as the car pitches like a rowboat in a hurricane. 

While MSF is secular, Mission GO is a Christian evangelical organization. But we think they’re a good match for Kindamba, where the majority of people are committed Christians. The people seem to agree, and have welcomed Mission GO with open arms.

We elected to hand over to Mission GO after visiting the impressive hospital they run up in the remote northern town of Impfondo. Another deciding factor was that nobody else was interested in taking over from us.

(Few would deny that the Republic of Congo is a bit of a global backwater. Even the UN accidentally routes shipments intended for this Congo to the larger and more infamous Democratic Republic of Congo next door.)

Mission GO director Dr. Joe is a friendly guy from upstate New York who speaks fluent Lingala. He has hired much of our beloved local staff to continue running the hospital, and has displayed stamina and grace under pressure in the battle to secure official assent for the handover.

Dr. Joe

Mission GO’s Dr. Joe Harvey heads into the jungle (of bureaucracy). 

Congolese are sticklers for protocol. Even a slight deviation from the unwritten social and political rules will get you an annoyed “Mais c’est pas comme ça que c’est fait!” (“That’s not how it’s done!”).

If you want to get anything done, you have to do it the right way. Which in our case meant clearing the Kindamba hospital handover with every government official and functionary from the minister of health all the way down to the guy who cuts the grass. Signed, stamped, and in triplicate.

Unfortunately, not only did we not get all our signed and sealed documents in order, we got lost in a murky political swamp of conflicting interests. And Kindambans started getting anxious that when the dust cleared they would be left without healthcare. We began wondering if our departure would trigger a resumption of the civil war, which is the kind of ironic farewell a good humanitarian aid organization should avoid.

A week after the handover, I wouldn’t say that Dr. Joe and Mission GO are completely out of the woods. But I think they’ve gotten off to the best possible start. The people are pulling for them.

And I have faith in Dr. Joe. When he was trying to set up the hospital in Impfondo, he also had bureaucratic obstacles to overcome. Then one day he ran into some American oilmen in Pointe Noire who asked him to accompany them to an important business meeting, because they couldn’t speak French. When he found himself interpreting for Congolese president Denis Sassou-Nguesso, he naturally brought up the Impfondo hospital. “What?” Sassou-Nguesso exclaimed. “That still hasn’t been taken care of?” He turned to his aide. “Get the paperwork for this hospital finished right now!”

So here’s hoping that this same serendipity or divine providence will continue working for our brothers and sisters in Kindamba.

Nurse Maartje is already back in Holland, and we put big boss Leonie on the plane last night. That leaves me and Dr. Ahmed to help close up the shop in Brazzaville. The gala dinners, long speeches over warm Primus beer, and tearful goodbyes have almost wrapped up, and Kindamba will go on getting on with its life.

New shops are opening, the market is busier than ever, and a few people seem cautiously optimistic. They’re talking about building a micro-dam on the river to generate electricity. And did I mention that the government recently repaired the bridges on the Loukouo-Mayama road? I wonder if there are any elephants out that way…

Save me some porcupine

April 18th, 2008 by jakew

The small village health centers we support have been exceedingly generous in their parting gifts, and every time our mobile team goes to drop off a final donation of drugs and supplies, we come back loaded with produce.

 

fish and tomatoes

A market quickly gets going beside our moble clinic in KIlebe Moussia

The cars roll into base bulging with live goats and chickens, bricks of foufou wrapped in leaves, buckets of oranges and papayas, giant banana bunches, huge bags of peanuts and vats of palm wine.

The chickens seem to travel pretty well, trussed up in woven grass carriers. The goats make more reluctant passengers, and have a distinctive smell that quickly saturates the vehicle.  

But nothing could really equal the odour of the parting gift offered by the town of Vindza. A porcupine! What a delight. This animal is considered a rare and precious delicacy all over the continent.

Apparently the hunters of Vindza had been saving this one for a while, and by the time it got back to Kindamba, it was obviously overripe. I came outside to greet the returning mobile team and the smell of the porcupine smacked me hard in the face.

 

food fight

The staff have a calm, reasoned discussion about how to divide the moble clinic spoils 

Inside a cloud of flies I could see Antoine carving up the animal and placing portions into the eager, outstretched hands of our staff. Dr. Ahmed was running around the compound spraying clouds of air freshener, which proved no match for the stench of rotting meat.

Dominique had been awarded the porcupine’s reeking, whiskered little head “You’re going to eat that?” I asked him. He certainly was. I was sure they would all end up in the hospital.

After a few days passed and nobody died, I asked Dr. Ahmed for an explanation. He talked about adaptation to the environment and local herbs neutralizing the toxins, but seemed a bit surprised himself.

I was happy to have stayed home from Vindza, but I made a mistake in not joining the last trip to Loukouo. That day the cars got back late, all the passengers tipsy from palm wine and singing and laughing uproariously. Apparently the villagers had thrown an epic bash, with a drumming group, singers, a theater performance and a big feast.

Victor, the head of the mobile clinic team, was glowing (and wobbling slightly). “You really missed a party in Loukouo!” he kept telling me. By the third time it was kind of annoying.

Willy and the cow

April 5th, 2008 by jakew

For our big project closure party, everyone was clear — we needed meat. Big meat. (Well not everyone. Nurse Maartje is a vegetarian and would be quite happy if we left the meat alone).

Kindamba used to be awash in cattle, but then the civil war broke out, and that was it for the cows. Rumour has it that the villagers are thinking of bringing them back, if the peace continues to hold.

Anyway, this is going to be a big party, and there’s no way we can feed everyone on chicken and fish. Fortunately we were able to track down a suitable cow a few villages away thanks to Willy, one of the MSF guards.

Apart from being a stand-up chap willing to do whatever is necessary to get a good party off the ground, Willy also used to be some kind of Congolese cowboy. He volunteered to go and retrieve the cow.Where Willy was going the Land Cruisers couldn’t follow, so his instructions were to escort our cow to a pick-up point on the Kinkakassa road. The plan seemed straightforward; Willy hit the road, and people began talking about recipes, occasionally lapsing into little beef daydreams.

Now and then Willy would climb a mountain in order to get cell phone reception and update us on his progress. Everything seemed to be going well until about the fourth day, when Eric came to see me wearing a grave expression. He had received a call from Willy. “The cow has escaped,” Eric informed me.

 

Rebel cow gets settled

Rebel cow gets settled after her long trip to Kindamba 

How the cow had managed to escape was unclear. I was confused because it seemed to me that the whole point of thousands of years of cattle domestication was that cows shouldn’t escape so easily, especially when there’s only one of them under direct human supervision.

The plan to recapture the cow was also vague. “Willy’s going to wait until dark. The cow will stop moving at night,” Eric told me. Stalking a cow through the Congolese bush at night sounded a bit off. But more experienced heads were nodding all around me, so I accepted this as the wisest course of action.

Days passed, rains fell and suns blazed, with still no word from Willy. Talk of a rescue mission began. But where to begin? The cow’s speed and direction were unknown. 

Finally, almost a week after departing Kindamba, Willy phoned in from a mountaintop near Mounkomo, where he was staying with the village chief. He had tracked the cow about 50km through the bush and had finally recaptured it.

 

Willy Batantou

Willy Batantou, Congo Cowboy, heads home for a bath and a long nap

“Come and get me,” he shouted through the static, sounding exhausted. “Bring food.”

Everyone was pretty surprised at how far Willy and the cow had managed to trek. Apart from being thoroughly impressed by his stamina and perseverance, I was excited about the rescue mission, because this meant a trip up the Kimba road and into wild elephant territory.

Alas it was not to be. Once known as a cowboy organization, MSF has matured over the years, and retrieving our own cowboy in unfamiliar territory would have required going all the way up the chain of command to Toronto headquarters, for official permission.

Since Willy wasn’t loitering on mountaintops, we had no way of communicating with him. Even if we could reach him, he would probably have been unimpressed to learn that we needed him to drag the cow another 30km south from Mounkomo to the Mbemba crossroads because of security rules. So we set about hiring someone to go and fetch him and the cow.

As it turns out, there are at least three villages in the area called Mounkomo. The one guy in Kindamba with a viable truck demanded an appalling sum of money to carry out the rescue mission, but we soon realized that he was planning to go to the wrong Mounkomo. When Eric explained that we wanted him to go up the Kimba road, he laughed and refused to make the trip at any price. Maybe he’s already seen the elephants.

Now if I had just chased a cow all over the countryside, I would have simply stayed put in Mounkomo growing increasingly resentful as my rescuers failed to appear. Fortunately Willy is a more sensible fellow, and when help did not materialize he began making his way south along the Kimba road.

As the prospects of hiring an independent transporter declined, we decided to send Eric and Richard up to the Mbemba crossroads to see if Willy might turn up. Eric was pretty sure he would.

When the rescuers radioed back to base to tell us they had found Willy and the cow alive and well, a great cheer went up. Once again talk turned to beef: recipes, butchery, and how to slaughter the cow in a Halal manner so that Dr. Ahmed could also partake.

The consensus was that Willy should be rewarded with the choicest cut, which around here is the head. Fine by me.

Bluffing

March 25th, 2008 by jakew

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.

vehicle_engineblock.JPG

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.)

HIV/AIDS program

March 24th, 2008 by jakew

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.

drs_ahmed_sam.jpg
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.

ida_box.JPG
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
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
Dr. Sam!

Trip to Vindza

March 18th, 2008 by jakew

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.

radio.JPG
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
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
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.

Meetings

March 17th, 2008 by jakew

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!”

Medical expat, Dr. Ahmed

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
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.
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.

Ring toss

March 17th, 2008 by jakew

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.

ringtoss at the nightmarket

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
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

MSF Kindamba storekeeper, Marcus and his daughter Iris.

Talangai Night Market

March 14th, 2008 by jakew

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.

marketsquints.jpg
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.

Turtle?
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.

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

OPD handover

March 9th, 2008 by jakew

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.jpg
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!”

msfsupply

discardit packs
Discardit packs.

msfsupply

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.

truck.jpg
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?