Oh baby

Dear Friends,

So I was looking forward to the free movies on the flight from Kigali and Amsterdam. At midnight, there was a call for a doctor as a woman was in labour.

We had an ace team. On board there was a midwife, a retired anaesthetist, a steward who is an intensive care nurse and myself. At 00:48, a health baby boy was born in the galley of KLM 535!


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Dear Friends,

Claudio and I are finally coming to the end of our mission in Kitchanga. The end of a mission is always a strange point in time where we have become familiar with the context and work but have completely run out of energy to continue our work.

The past few weeks in the mountains have been hectic. Due to increased fighting in the region, more and more IDPs [internally displaced people] have been coming into the areas we work in. In Bibwe, there is an estimated 15,000 IDPs who have settled in the villages in the forest around Bibwe. In Kivuye, there are 2083 new IDPs who have been integrated into the refugee camp.

Due to increased overcrowding and a risk of a measles epidemic, we started organizing a Measles Vaccination Campaign in collaboration with the Ministry of Health. The target group of a campaign consists of children aged six months to 15 years. In order to provide sufficient herd immunity, a coverage of 100% is required ie: all children need to be vaccinated. In reality, a result of 75% coverage is acceptable. A vaccination campaign is a huge logistical exercise. It starts with getting the approval from the Ministry of Health. This is followed by a population count, calculation of supplies required, ordering supplies, sensitizing the community as well as informing all actors in the area. One of the primary activities is choosing a suitable site and setting up the vaccination circuit. The site needs to be of a suitable size with a waiting area, one entrance and one exit on opposite sides, space enough for the registration team, team for oral medications (vit A and albendazole), vaccination team, preparators of the vaccines as well as a storage and disposal facility.

Kivuye was chosen as the first site for the vaccination campaign for several reasons. In terms of medical need, two cases of measles were identified. For logistical reasons, Kivuye was chosen as there is a functional fridge in Kivuye Health Centre and the new IDPs have been integrated into the official camp. In contrast, the IDPs near Bibwe are scattered in the fairly inaccessible villages in the forest. We planned a Monday to Saturday visit (8-13 Oct).

Spirits were high and everybody was buzzing with excitement as we threw ourselves into the campaign. In the first two days of our campaign, we had vaccinated 3096 children. Unfortunately, midway during the campaign, we were contacted by our base in Kitchanga. Security in the mountains had deteriorated and we had to halt the campaign and return to Kitchanga. As it was too late in the day to drive back to Kitchanga, our team had to stay the night at Kivuye. We were unable to drive to Mpati to retrieve our belongings in our Maison de Passage. Fortunately for us, it was market day in Kivuye so we were able to buy a goat, potatoes and cabbage for our evening meal. When the population heard that we were staying in Kivuye, they started coming to the health centre with their pots, pans and kitchen utensils. We even received a bag full of spring onions. I was very touched by their kindness. These people had so little for themselves yet they were giving us what little they had. That evening, as I held the security briefing with the team, we could hear the heavy pounding of artillery in the distance. Temperatures dropped in the night. We did not have blankets and only had the clothes on our back. We curled into little balls as we tried to conserve what little heat we had.

The following morning, we handed over our vaccination circuits to our staff in Kivuye and drove back to Kitchanga. Everyone was dirty and exhausted when we arrived at the base. As always, we have a debrief after each security incident. During the debrief, we were able to talk through the worries and fears of everyone involved. It was actually quite a relief to me that most of the staff were more concerned about the belongings they left behind then the stress of the evacuation.

Our staff in Kivuye sent us the final results of the vaccination. Due to insecurity, after we left Kivuye, the staff were only able to vaccinate a further 750 children over the next couple of days. Overall, 3846 children out of a target 5010 children were vaccinated. This reflects a coverage of 77%. Not bad in light of the difficult conditions we were working in!

Claudio and I have flight tickets out of Congo next Wednesday. We are crossing our fingers and if all goes well, this time next week, we will find ourselves among family and friend we have not seen for a long time.



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Dear Friends,

A couple of months back in May, I had written to you about the mass population displacement due to the movement of armed groups in the mountains. Many of the families come from mainly three camps of villages – Nyange, Bibwe and Kitso. They have now settled in Mpati which is a village we work in. The new déplaces [displaced people] are located mainly on the hills around our Health Centre and at a nearby UN base. Our team was tasked with performing a rapid initial assessment of the needs of these déplaces. At that time, our outreach workers had helped us with the population count and latrine assessment. Our Watsan team assessed the water sources. In May, we counted 1,830 people. They were using the 4 latrines of our health centre and a contaminated water source at the bottom of a valley.

As a result of the exercise and community questionnaire we administered, we were able to generate a significant amount of data and transmit the needs of the population to several other NGOs and WASH (water/sanitation) actors. Since then, we had performed a soap distribution and constructed 40 latrines. Solidarité, a WASH actor, constructed another 112 latrines, built showers, dug up waste areas and rehabilitated the water source.

Our work is never finished. Our outreach workers performed another population count in June. The population of déplaces has since swelled to 6,320 people. The ratio of people to latrines is 41.6 people per latrine. With only one water source available, each person has only an average of 4.2L of water per day for all their needs (drinking, cooking and cleaning). Just as a reference point, we use guidelines set out by the Sphere Project. This project was launched in 1997 to develop a set of universal minimum standards in core areas of humanitarian assistance. It recommends that there should only be 250 people per tap and calculates that the total basic water needs per person is 7.5-15L per day. It recommends that there be not more than 20 persons per toilet but allows 50 persons per toilet in the acute phase.

We are also struggling with the dynamics of Mpati. The village Mpati has an existing IDP [Internally Displaced People] camp, Camp Mpati, of 14,714 people. This is an officially recognized camp and hence the IDPs qualify for aid. Within the new déplaces, only the group from Nyange qualify for aid as they come from another officially recognized camp. The remaining déplaces do not qualify for aid, in the sense that they are not on an official list when there is a distribution of food and non-food items. Due to insecurity in the area, they have not been able to go to their fields or pasture lands. Their situation has become more desperate with time. Some families have been forced to steal from their neighbours and food from the nearby fields. This has created a tension in the camp.

I often throw up my hands in despair. Just when we intervene and things start looking up, new problems crop up. I once asked Claudio why he works for MSF. He shrugged and said…’so I can use my skills with the right people in the right place’.



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Dear Friends,

One of the areas we work in when we are in the mountains is a village named Bibwe. It is remote. There are hardly any vehicles that go there and there is dense foliage on either side of the road. We are the only NGO which works there. Another NGO had rehabilitated the road just till Bibwe. It is fascinating to see where the road ends and the forest begins.

For the past year, our team had been doing weekly mobile clinics in Bibwe. In March 2012, after intensive repair and construction works, we finally established Bibwe as a permanent health centre with a basic package of primary health care, staffed by nurses from the health ministry. Soon after, fighting began between different armed groups. The population was looted. Hundreds of families left Bibwe for safer villages. Our staff in Bibwe were obliged to evacuate for their safety. Our health centre was pillaged twice. Medication and furniture were stolen. Our Watsan (water sanitation) items were damaged. Men had broken the concrete covers over our waste pits thinking that there was money hidden there, they broke our sharps receptacles looking for money, they slashed our water tank with machetes, they broke our latrines and stole the plastic sheeting.

We were finally able to return to Bibwe in May. It was a very slow start as our trips were often interrupted for security reasons. Our health centre in Bibwe could only function as a health post with the most basic of services. This was a frustrating time for everyone. Delivering babies is an integral part of our healthcare. However, we were not able to provide this service as we did not have adequate materials. Women were asked to go to Mpati for their deliveries. Mpati Health Centre is another structure that we support. It is a 2 hour walk. However, due to insecurity, these women were choosing to deliver in their own homes.

I felt sad as I walked around Bibwe village near our health centre. What used to be a busy, lively village was now a collection of burnt out homes. I had a chit-chat with some women who were coming back from their fields with their crops. They were heading to Mpati where they were now living. I asked if the journey between Bibwe and Mpati was safe. They smiled and shrugged….”It depends on our luck. Sometimes no one stops us. Sometimes we get stopped by armed men and they either take everything or leave us something. The men are not violent as long as we do what they say. All our corn was stolen from our fields but at least we did not lose all our crops.”

In the past couple of weeks, we have finally managed to deliver water tanks, furniture and other materials. We have started our maternity services and we will finally function as a 24h health centre next week.




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Waking to the sound of gunfire – again

Dear Friends,

Moving house is never fun, especially in the mountains. Recently, armed groups had been pillaging the village we normally stay in during our trips in the mountains. The attacks were increasing in frequency and occurring every night. Despite our demands for humanitarian space to work in, we awoke to the sound of gunfire and panicking villagers screaming and running.

The weaponfire continued for at least 3 hours. During that time, the whole team took shelter in the safe room. When the gunshots ceased, we all went back to bed. The sounds of villagers beating on jerrycans and making whooping noises to scare away the pillagers continued on all night. We decided to cut our trip short and return to Kitchanga the following day. For two reasons mainly. The first was the safety of the team and the second the second was that we cannot work in conditions where our safety is not guaranteed.

This week, we found another house in a nearby village where we have our health centres. The villagers are hospitable, the view beautiful. Our very essential logistician was unable to come on the trip this week. There was much laughter when the drivers and nurses attempted to construct a kitchen and shower with bits of wood, bamboo, plastic sheeting and 2 kitchen knives. There was muffled giggling when the kitchen collapsed after 2 minutes of drizzle. The mountains are very remote. Children are unaccustomed to seeing foreigners. I drew a big crowd when I started peeling potatoes and plantains.

We were extremely busy this week during our visit to the mountains. I was particularly affected by a couple of cases. The first was a lady who had been held in captivity by an armed group in the bush for 5 years. She finally escaped and sought help at our health centre. She arrived with 3 little children. She was worried about the HIV status of herself and her children. She could no longer find her existing family and had nowhere to go. We eventually brought her to Mwesso hospital for sexual violence counseling and psychosocial support.

The second case was a 3 year-old girl. She was carrying her baby brother on her back when a tree fell on them. Her brother died. She was brought into our Health Centre unconscious. Thankfully, all was well. After 24 hours, she had started eating. She smiled very shyly at me as I examined her.

As the press releases report, there is much population displacement and movement of armed groups. Without quite realizing, Claudio and I have been here for almost 4 months. We are both a little tired and very much look forward to our holiday. We will be leaving Kitchanga end of next week and will spend about 10 days in Zanzibar.

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Safe room

Every day is a new day in our little town. Our trip to the mountains was cancelled twice this week due to weather or security reasons.

We awoke to the sound of gunshots at 6am on Thursday morning. They were louder than normal. All the expats and our guards and driver piled into the safe room. This is a rather uncomfortable small space underneath our stairs which is protected by concrete and sandbags. I am glad that Claudio was with me.

Our safe room has communication equipment and we were able to keep in touch with the guards at our office and the health post. A large number of our national staff had also sought refuge in the safe room at the office.

Apparently a number of soldiers had not been paid. As a result, they attempted to pillage some houses in town. In order to repel them, the military police together with the community started shooting and throwing stones at them. The gunfire lasted for 3 hours. 12 gunshot injuries were received in the hospitals. Soon after the weaponfire ceased, life on the streets resumed activity as per normal. Our local deejay started playing his loud music on the street, children started playing in the streets and Mamas started going to the market. I am not sure if this is resilience on the part of the community or a form of disassociation and coping with stress.

On a happier note, Claudio and his team of counselors performed a play which addressed issues ranging from domestic violence, rape and alcoholism. I watched them perform in one of the IDP camps near our house. Although it was only seven in the morning, there was big crowd of spectators. Claudio played his part very convincingly in Swahili. It was a lively spectacle and much interaction between spectators and actors. Loud applause for the heroes and boos for the villains. One of the more ancient Camp representatives waved a big stick at the ‘drunk’ actor and shouted out ‘people like you are not allowed in our camp….beware of loose women… they will always take your money and leave you!’

We are all a little tired. Most of the team has gone to Mweso to participate in a football game. I very much look forward to pottering around the garden and kitchen this weekend.




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Mother Nature has the last say on our activities on the mountains. We use either of two roads to get to the health centres in the mountains. We label them the Quebac axe and the Victor axe.The Quebac axe is a shorter route for us. At the best of times, it takes us 3 hours to get to our destination. The Victor axe is a longer route. It is a journey of approximately 5 hours but road conditions are less capricious.

Thunder and rainstorms churned the Quebac axe into a pool of mud. We travelled with a land cruiser and a small truck. The going was tough. We never really got stuck but we had to either pull out other big trucks or dig out enough space along the sides of the mountains to get past them. Our spirits remained high. We were determined to get to our destination as we had to do a soap distribution and finish construction of 40 latrines.

6 cold, muddy and wet hours later, we were 1.5km from our destination. We were finally defeated when a landslide came between us and there. It was almost evening and we had to drive back to the nearest village to take shelter. The people there were hospitable and allowed us to stay in their health post. One of our drivers is a fantastic cook. A couple of hours later, we huddled together over warm coal braziers eating a delicious dinner of meat stew, cabbage, rice and potatoes.

We left bright and early the next day, sending messages before us that we wanted men to clear the landslide for us. To our great disappointment, there were now 4 landslides and not just one. We yelled out words of encouragement to the team of 40 men as they dug out the landslides. Alas, after 3 hours of digging, we were still unable to squeeze through the passage that was created. The 6 hour drive back to Kitchanga was not easy. The trucks we had helped extract the day before were stuck in new places and we had to help drag them out again.

I nodded my head very slowly and carefully when our Project Coordinator asked me if I wanted to try to get back up to the mountains via the Victor axe the next day.

The journey the next day was a breeze. We got to the mountains, we gave out the soap and we built the latrines.

I was of course completely exhausted after the trip. Lovely Claudio baked a delicious chocolate/pineapple cake and sat through multiple episodes of ‘Sex in the City’over the weekend with me.

Angie Xx

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Mass displacement

The past month has seen movements of different armed groups and mass population displacement in the areas in the mountains where we work. My team and I were tasked with making a rapid initial assessment of the needs of the newly displaced in two villages. This was not something that I had done before. As always, MSF provides for the inexperienced. There was a 120 page manual with step-by-step instructions on how to set up an assessment exercise, collect data and implement whatever needs to be implemented.

Our team was appalled by the living conditions at the first village we assessed. There were more than 3000 people squatting in two schools and a church. Each family had a small area where they kept all their possessions, lived and cooked. They were using latrine facilities of their neighbors and the buildings. There were only 12 latrines available. They had no cleaning material and were using grass to clean themselves and the buildings. These people had no privacy and little dignity. They were hungry, cold and desperate. Later we learned that these people eventually moved to Kitchanga as they feared for their security.

The second village we assessed is the same village where our health centre is located. The landscape had changed dramatically from our last visit there. There were 2000 newly displaced people who had started building shelters next to our health centre. They had no latrines and were using the four latrines of our health centre. There was an outbreak of diarrheal diseases. Desperate for food, many of the families had sold all or most of their belongings. Families had only one jerrycan to transport and store water for their daily needs. Those who were lucky had 20L jerrycans. The not so lucky ones had small 5L ones or had to borrow containers from their neighbors. As we had a good contact network in the community, we were able to construct a couple of temporary latrines and a zone of defecation to relieve some of the pressure the displaced were exerting on their environs.

Much more needs to be done for these displaced people. We are visiting again next week to do a soap distribution and complete construction of 40 latrines.



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Frenzied hub of activity

In a town not too far from Kitchanga, a minivan packed with passengers was fired upon by armed men in the early hours of Saturday morning . By the time people came to ask for our help, the community had carried the injured to a nearby health centre. We were informed that there were 5 gunshot injuries.

Our office became a frenzied hub of activity as we threw our emergency equipment into the ambulance and drove towards the health centre. We drove past the empty minivan. There was glass everywhere. The crowd pointed us in the direction of the health centre.

The nurses at the health centre had done the best they could with the patients. There was a lady who had been travelling with her two little children. She had been shot in her chest. She was lucky as the bullet had lodged in muscle and did not hit lung. The next gentleman was not so lucky. He had been shot in both shins. He had several fractures and there was a pool of blood on the floor despite the tourniquets that the nurses had applied. He was conscious but we could barely feel his pulse or get a blood pressure reading. The three other patients had relatively superficial injuries.

All five patients were placed into two of our ambulances. Radio contact was made with another MSF team at Mweso hospital and their emergency plan for mass casualties was activated. It was a least an hour’s drive over bumpy roads. I cringed when the patients cried out as we navigated the potholes.I was much relieved when we were greeted by friendly professional faces. The two most serious casualties were whisked into surgery within minutes of our arrival.

After the patients were finally stabilized, I drank a cold Fanta and headed back to Kitchanga, sending silent back-pats to each and everyone who helped along the way. I was happiest when I finally relaxed in Claudio’s gigantic hug.

News from the hospital is that the lady has a haemothorax but is stable, the gentleman with the broken legs survived the operation but is being kept under close observation.

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Fire in the mountains

Dear Friends,

Claudio came with me to the health centres in the mountains this week. We were giving a joint training session to the staff in the health centres. The rainy season has started. Everything is more lush and green. The mountains were especially beautiful this week. They were shrouded in mist and the orange of each sunset was diffused through the clouds.

Most of our first day was spent on the road and at Kivuye Health Centre. Back at our Maison de passage in Mpati, the team had prepared fresh beignes (deep fried dough balls) for the evening. They were hot and oily. Claudio and I rolled them in cinnamon and sugar. Perfect when washed down with a hot cup of tea.

We were just starting to relax and chat with the team when we saw huge flames licking the night sky. One of the village huts had caught fire. Our men ran out with their spades and put out the fire with sand. The house belonged to a young lady who had just given birth to twins. She had dashed out with her babies. Happily there were no injuries. We spoke to the camp president. We were encouraged to hear that the community was going to build a new hut for the lady.

We spent the second day at Bibwe Health Centre. My heart sank when I saw a group of men coming towards us with a lady on a stretcher. They were tired from the journey but remained gentle as they brought her into the observation room. She had suffered serious burns to her left arm, left buttock and left leg. Her husband was with her. He had burns on his hands as well.

They had been travelling to their field to harvest their crops. They had taken shelter in the bush during the night. Unfortunately, their shelter had caught fire when they were preparing their evening meal. They had travelled through the night to get to us. Her family was with her. The lady was in obvious pain as we dressed her wounds. We brought her back in the car with us and sent her to Mwesso hospital.

It is difficult to convey the picture of poverty we encounter with the communities in the mountains. Little children are carrying even smaller children on their backs. People are mostly barefoot or wear plastic slippers. They walk great distances just to get enough clean water to drink, cook and clean. It is heartening to see the strength of the community when they come together to help one in need when each person has so little to share.



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