Medicine by Motorbike

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.

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

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

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.

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

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.

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.

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.