30 April 2009 Comments
This past weekend, I went on a 3-day trip to the field with my senior log assistant and project coordinator. Our destination was Manono, the nearest ‘cité’ to Shamwana and a short 6-hour, 170 km drive away. Our main goal was to explore local purchase opportunities and the ability to use the twice weekly flights from Manono to Goma as a way to get expats out of the project.
So good to get out of the base and it was great to see another corner of the DRC. It also gave me lots to think about and I’ve shared some of these thoughts over the next couple of entries.
Ministry of Health
We started with a short side trip to visit the doctor in charge of the Ministry of Health side of operations in 4 of the 6 health centers we are supporting. This is as high as it gets without going to Lubumbashi so that was interesting. Got a few documents signed, discussed the incentive to be given to the new “Directeur de Nursing” recently posted to Shamwana and picked up a few motorcycle parts that we had lent them during their last visit.
Getting there was fun. A 5-hour driver, crossed a wide river by row boat and then it was a 2 km walk to get to his office. The office is on the same grounds as a large 50-bed Ministry of Health referral hospital and is in the center of a large village. Access by boat is the best option as there are no bridges and it is at least a 2-day drive to the nearest barge.
Before MSF opened in the area, all serious cases from the health centers we support were referred to this hospital. That’s pretty crazy. 5 hours by car or at least 2 days by bicycle meant that most people just wouldn’t bother. In the end, this is the main reason for opening our hospital here in Shamwana.
The most shocking part was the total lack of drugs in this hospital. There weren’t many patients either but, without medicine, why bother coming?! Our small health centers are better stocked then this 50-bed hospital! Is this what will happen in our region when we close our project? We can build the buildings, train the staff and implement as many protocols as we want but who is going to buy the drugs or pay the staff once we’re gone? Definitely showed me that the Congolese government is not ready to take over just yet.
Before the war, Manono was a pretty happening place. Post office, electricity, trade schools, running water. Big tree-lined boulevards with promenades and nice shops on either side. There was even a section of town with paved streets and huge European houses.
Mining was the mainstay of the economy and, under the Pro-Western government of Mobutu, a handful of foreign companies were busy pulling as many minerals out of the region as fast as they could. With the outbreak of war, all of these companies pulled out and none have returned. Hundreds of individuals now comb the tailings piles in hopes of finding something they can sell in what is now termed “artesian mining”...but there hasn’t been steady work in the mines here for quite a while.
When people ask how was Manono, I tell them that it used to be a nice place. There are rusted out cars sitting on blocks in a few of the yards. Beautiful European-style houses are vacant and overgrown. Stores lining the boulevards are boarded up and there really isn’t so much traffic anymore. While there is a lively market, there isn’t really much in terms of shopping and prices are high because everything is either flown in or comes hundreds of kilometers by truck.
The hydro-electric plant that supplied power to the entire region was build by the Belgians in the 1960s. It survived Independence and stayed operations throughout Mobutu’s regime when so many of the other services were neglected. It wasn’t until 1998 when troops, advancing in their successful coup to overthrow Mobutu, stole the transformers and took them back to Rwanada.
5 years of war followed and the plant is now far from functional. Transmission lines were stolen and sold for their copper. The water channels feeding the power station developed leaks and flooded the buildings. Tin sheets found new homes. Instead of providing power for tens of thousands, the locals now use this relic as a good place to fish.
I’m still not sure how I feel about the gross exploitation of natural resources in this area. It is true that not much (or any!) of the profits stayed in the DRC. It is also fairly unlikely that there were Congolese living in the fancy European-style houses. But there was work and that has to count for something. Without the mines, there are so few options for employment. There is no electricity. No roads or bridges will get fixed.
Following the war, Manono was a hub for NGO activity. A number of organizations started projects and a large MONUC base was opened. Now, as funding to aid agencies continues to be diverted to the Kivus, one by one these NGOs are closing shop and employment opportunities spiral downwards.
In effect, the population is living on the edge. Medical services are extremely limited and food security is low. Rumors of malnutrition are circulating. Roads exist but are barely passable. School teachers are paid $30 US a month. True, there is no longer war in Katanaga…but the population is not out of it just yet.
From my perspective, the trip was a success. The project coordinator caught her flight to Goma and will cross into Rwanda to catch an international flight to Nairobi for a training course. Sound complicated? THAT path is currently the easiest way to get out of the country from Shamwana!!
I was also able to buy simple things like fresh eggs, tomatoes, oranges, garlic and onions, eggplant, papayas, bicycle repair parts, scribblers, engine oil, a few raincoats, and some plastic sheeting. Most of this stuff isn’t available in Shamwana…and, if it is, it is way more expensive. We haven’t had a plane land in Shamwana for over 3 months so it was nice to have some fresh vegetables for the weekend!
On the way back, we spent the night at a health center that was outside of MSFs ‘radius’ of support. In late 2008, the NGO that had been supporting this heath center (and many others) suddenly lost its funding and abruptly pulled out of Katanga.
Blamed on the global economic crisis, this departure suddenly left 21 health centers across two regions without adequate medical supplies. The health center where we stayed was no different. They had nothing…and what little was there was expired. No antibiotics. No drugs for simple malaria treatment. Not even a thermometer.
We pulled up at 5:30 pm and I was immediately called inside to see a 2-year-old girl with a severe case of malaria. For me, this is one of the hardest parts about working with MSF. Patients and health centers and hospitals are all pretty new for me but I manage ok. It is when I walk into a clinic or hospital as a white expat wearing my MSF T-shirt and it is assumed that I am a doctor that it gets a bit uncomfortable! Hard to explain to a mother with her sick daughter in her arms that I’m (just) the logistician and not actually able to do anything to help…
I am not a doctor. But part of my job as a logistician is to make sure that every car leaves the base with a fully stocked emergency medical kit for cases just like this one. I opened the kit and asked the Ministry of Health nurse if I had what he needed. I did. He was so grateful and, within an hour, an injection had been given, a drip had been setup and the child’s fever was going down.
“Saving Lives and Alleviating Suffering”
She made it through the night but still needed a blood transfusion…so at 6:00 am the next morning we loaded her into our land cruiser and transferred her to the MSF hospital in Shamwana. Both parents were asked to come along in hopes that one of them would be a compatible blood donor for their child….
She got the blood transfusion and she lived.
Malaria is the number 1 killer of children under 5 in Africa….but at least this was one less case for the statisticians!
The incredible part of this whole situation was that there was a Ministry of Health nurse at the health center and he actually knew what to do. Physically, there was a health center. There were patients. The only thing that was missing was the medicine! It is so painful to know that everything else is in place, but without NGOs providing drugs the whole system falls apart!