Congolese heat to British winter

March 31st, 2010 by Field Blog Editor

This will be my last blog from Kitutu, as I am at the end of my contract and heading back to England next week.  I’m starting my mental preparations to adapt from jungle living in the Congolese heat, to city living in the British winter.   Having spent the last 5 years working on humanitarian projects in Africa, with short breaks in between each mission, the effects of “culture shock” have faded. There are always a few things which manage to stop me in my tracks when I get back to England…the choice of products in the supermarkets, the anonymity in the streets, the bombarding of adverts…but it doesn’t take long to get back into the swing of my other life.

What is more difficult is to keep the memories alive – the sights, sounds and smells.  I think that Congo, more than other countries I have visited in Africa, can overwhelm the senses.  The love of Congolese people for music is renowned. You cannot listen to a popular Congolese song on the radio without a few people getting off their chairs (or motorbikes!) to dance.

The sound which I will be happy to forget is the church bell in Kitutu at 5.45am each morning, just 20 metres from my bedroom.  In fact it is not really a bell, but a metal container which is hit very hard with a stick. It seems to do the required job however of waking up the whole village.

A sight that will stay with me is of women all day long carrying out endless chores to make sure their family can eat in the evening.  From morning to evening, you see the women working in the fields, collecting the water and firewood, preparing the foufou, grinding the manioc leaves, washing the clothes…the list is pretty endless.

Trying to make foufou in Kitutu.  At least my team were kind enough to eat what I had prepared.

Trying to make foufou in Kitutu. At least my team were kind enough to eat what I had prepared.

Last Sunday I spent the morning with our cook in the kitchen.  I asked her to let me prepare the meal for our team, with her guidance.  I spent the next 2 hours sweating in the kitchen as I ground the manioc leaves with a 1m wooden pestle, and mixed the manioc flour with boiling water to make the foufou.  By the end, I had an even deeper respect for the burden which Congolese women live with every day.  I was exhausted, and I hadn’t even done any of the preparation work to fetch the water and make the fire.

There are many other sights which I will not forget from Kitutu – the rickety bridges which I was so nervous to cross on the first day; groups of young children jumping up and down with excitement to see a muzungu woman arrive in their village; the bicycles piled so high with merchandise that you can’t even see the person pushing it; the incongruous mix of gold mines in an area of such poverty.

A young boy standing outside a shop selling gold

A young boy standing outside a shop selling gold

As for the smells, the one which I love the most here is the rain on the dusty roads.  Unlike at home, where the umbrellas go up and the head goes down in a bid to reach the destination as soon as possible, out here the rain puts a smile on people’s faces.  Especially the children.  That first smell of rain is an open invitation for children to strip off their clothes and go and jump in the huge puddles.

Me with helmet

Me with helmet

So while the MSF team will continue to provide medicine by motorbike to the displaced families around Kitutu, I will be heading home with some of these memories in my mind.  Thank you for reading, and until the next time.

Needs

March 23rd, 2010 by Field Blog Editor

One of the MSF priorities when deciding whether to open or close a project is to be “needs-driven”.  It is one of the reasons that I like working for MSF.  This means designing projects, not because they are easy for MSF to access, but because there are real humanitarian medical needs that have been identified during an initial assessment.

Defining “needs” can sometimes be difficult, so we use terms like “vulnerability” to target certain groups who are those most in need of assistance.  Some examples of vulnerable groups can be : displaced people, malnourished children, war-wounded, widows, orphans, victims of sexual violence, people living with HIV/AIDS.

In Bakongo health centre after a mobile clinic

In Bakongo health centre after a mobile clinic

On paper, these groups are quite easy to distinguish.  In the field, it can be a bit more complicated.  It is one of the reasons that our team is in Kitutu at the moment, to assess the level of vulnerability of the population.

I met a woman this week who is now a widow, living alone, after her husband and 7 children had all died over the last 5 years, either from illness or as casualties of the ongoing conflict.  When she was displaced from her village a couple of months ago, she came to the village where we have since started our mobile clinic.  As with other displaced people, she went first to the local chief of the village to ask for somewhere to stay.  He found her an abandoned hut which she now lives in.  It has a leaky roof, a broken bed and no door, but it will be her home until it is safe enough for her to go back to her village.

It looks pretty bleak.  However, at least she is in a village where the community has really tried to help the newly displaced arrivals.  Everyone has donated something, whether a bucket, a saucepan or a jerrycan, so that the displaced families in this village have the very basics they need to eat, drink and wash.

So would this woman be considered as “vulnerable” by MSF? Of course.  But we have to be careful that we intervene in projects where the impact, especially medical, is clear.  There are many people in South Kivu living in conditions like this woman.  And our resources are not unlimited…

We are not only here to assess health needs though.  We are also providing direct medical assistance through mobile clinics to some of the more remote parts of the health zone.

In the last 3 weeks, we have carried out more than 2,100 free medical consultations, most of which are for displaced people. That is more consultations in 3 weeks than the monthly total for the 22 health centres in the whole of the health zone of Kitutu!!  We have screened 4,630 children under 5 years old for malnutrition , and have found that almost 300 are malnourished, of which 82 have severe malnutrition, who have started the necessary treatment.

When it comes to mobile clinics, there are not so many questions to ask yourself.  You see the impact of MSF´s work every day.

A day in the life…

March 1st, 2010 by Field Blog Editor

To give a better idea of what it is like to be running mobile clinics in remote parts of Eastern Congo, here is a little summary of what I did today…

The alarm goes at 6am.  I take a quick breakfast with stale bread and marmite (an essential item on any of my field missions!) before we load up the motorbikes with the rucksacks packed with medicines.

Its 2 hours along bumpy forest tracks to reach the mobile clinic site.  There are little children who wave and shout “muzungu muzungu” (white person) everywhere I pass. If I´m not holding on too tightly to the motorbike, I wave back.

jungle track on motorbike

I think we must be the first motorbikes to pass along this track for a long time. The grass is so high, we can hardly see where we are going.

On arrival at the health centre where we are running the mobile clinic today, there are hundreds of mothers and small children waiting for the nutritional screening.  They all start cheering when they see our motorbikes arrive.

We are a bit short-staffed today so I spend the next 5 hours helping my colleague to measure the upper left arm of all children under 5 years, a way to see if they are malnourished or not.  Any children who are malnourished or ill are then sent for a consultation.  The healthy ones can go home.

Some of the younger ones are a bit scared when they see a muzungu so close to them.  I send these ones over to my Congolese colleague for their screening.

By around 1pm we have finished the screening, but the MSF doctor now has a long queue of patients outside his consultation room.  I leave him to it, and go to explore the village where we are working.

I meet with the local chief, who tells me about the recent insecurity in the area and the arrival of displaced families.  He takes me to visit the homes of some of the displaced families so I can get a better idea of their living conditions.  There are often 2 or 3 families living in very small spaces.

I go back to the health centre as the doctor is finishing.  I chat with the nurse in charge of the health centre.  He jokes that he is trying to find me a husband from the village so that I will have to stay here longer.  I tell him that I wouldn’t make a very good local wife.

He tries to tempt us to eat one of the local delicacies before I leave…a type of hairy worm. I decline quickly, saying we are already late.

We get back onto the motorbikes to return to our base.  The rainstorms are threatening, but luckily we arrive back before the they start.

A quick shower with a bucket and cold water. Finally I get to eat the first real meal of the day: foufou, sombe (a bit like sour spinach) and goats meat.

I spend an hour in the evening filling in the statistics for the day, while the nurse refills the medical bags for tomorrow morning from our little pharmacy.

For those who are not too tired, we will play a few rounds of cards this evening before heading off to bed. We still have another 5 days to go before we reach Sunday.

And the queues get longer…

February 22nd, 2010 by Field Blog Editor

As the message spreads that MSF is providing free healthcare through mobile clinics, the length of the queues of patients awaiting our arrival each morning is growing. Our MSF doctor and nurse are getting used to doing 10 hours of back-to-back consultations, with only time for a few bananas to eat during the day!

Some of the bridges we cross each day to get to the villages

Some of the bridges we cross each day to get to the villages

Once the mobile clinic is ready each morning, with the patients organised, I leave the medics to their work, and go off to talk with the inhabitants and displaced people living in the nearby villages.

Visiting the makeshift homes where the displaced families are living is always a sobering experience.  Some of the families I visited this week have been in the village for 6 months. This is usually considered “enough” time by humanitarian standards for a displaced family to be self-sufficient. For the families I visited in Byunga, this is far from the case. Most families are living with 8-10 people in a space of 3m², often inhabiting the kitchen or storage room of one of the residents of the village. They are sleeping on straw mats on the floor, no blankets, sheets or mosquito nets.

One of their biggest daily problems is how to collect and store water. No-one was able to bring anything from home when their village was attacked. They can borrow a jerrycan from a neighbour for an hour or two to collect water, but then they have nothing to store it in. Even the simplest tasks become incredibly difficult in these conditions.

In other villages, I have been meeting more recently displaced families, many of whom fled their villages around early January after they were attacked. Out of 40 families I spoke with yesterday, 8 of them told me that a family member had been captured during the attack on their village by armed groups. Most of them had been released after a week, but had been badly beaten.

These families face a difficult dilemma: they can sleep in the forest at night close to their village, so they can still access their fields, but risk further attacks. Or they can move 15-20km to the nearest small town where there is more security but they will have problems for finding food. The lucky ones have got family members living in town who can support them, at least for the first month.

Some of the bridges we cross each day to get to the villages

Some of the bridges we cross each day to get to the villages

MSF is helping these families for the moment by providing free healthcare – hence the huge numbers arriving at our mobile clinics. Due to the high fees for consultations in this area, for many displaced families, it is their first access to healthcare in many months. We are also discussing with ICRC whether some basic household items can be distributed in these villages, as they have already started doing this in other nearby areas. One of the biggest challenges would be how to distribute bulky items like jerrycans in areas where there are no roads… access is by bicycle, motorbike and foot only.

Mobile clinics and the six-hour commute

February 8th, 2010 by Field Blog Editor

Two months after carrying out a health assessment in Kitutu, South Kivu, in eastern Congo DRC, I have returned with a small team to run mobile clinics for the local population, in particular the displaced families.

The recent military operations in this area in late 2009, and the subsequent reprisal attacks by armed militia, have forced thousands of families to flee their homes. Many villages are now empty, while others are growing with the arrival of the displaced families. It is common to find 3 or 4 families living under the same roof. Our aim is to provide temporary medical assistance during this period for the most vulnerable families.

Mobile clinic in Mapale

We have selected the most remote villages for our mobile clinics, where health centres rarely have the medicines they need to treat some of the most basic illnesses. The health zone of Kitutu is already pretty remote, a 10 hour drive from the main city of Bukavu in South Kivu. Even before the recent insecurity and displacement, the health care facilities here were providing only a bare minimum or services.

Our team sets off at 6am each morning on motorbikes, since there are no roads around here, just dirt tracks through the jungle, around the mountains, with rickety bridges over the numerous rivers. We load up our rucksacks full of medicines on the back of the bikes, and spend up to 3 hours on jarring paths to reach our destination. Each evening, we do the return journey to Kitutu.

It is an exhausting but exhilarating way to provide medical care to those who really need it. On the first day of our mobile clinic, after spending 6 hours on a motorbike, I fell into bed at 7pm.

While providing free health care through the mobile clinics, we are also asking questions to the displaced people who are coming for consultations, to get a better understanding of their situation. To give an idea, I spent 8 hours yesterday during our mobile clinic asking questions to displaced families. Out of 90 families I spoke to, I found out that:

  • 82 families had fled during a direct attack on their village
  • only 1 family had been able to bring blankets and jerrycans when they fled – two of the most basic items needed by a displaced family (I hope we could bring with us some non food items, but with the motorbikes this is almost impossible)
  • 9 families had experienced the death of a family member during the attack on their village
  • 40 families still had no news about some of their immediate family members following the attack

The demand for our free medical care is astounding. The nurses in these health centres are amazed by the hundreds of people arriving at our mobile clinics each day. They are used to doing 5 or 10 consultations each day! We are going to be kept busy over the next few weeks…

Biography: Harriet Cochrane

February 8th, 2010 by Field Blog Editor

Harriet CochraneHarriet Cochrane is a project coordinator for MSF, currently working in the Democratic Republic of Congo. Originally from Oxfordshire in the UK, Harriet has previously worked for MSF in Niger and Uganda, as well as having field experience with Merlin and Solidarite.