OPD handover

09 March 2008

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.

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!"

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.

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?