From Bunia

On certain days I ask myself if we were right to get involved in Bunia in the first place. There are hundreds of NGOs here, many of whom are now thinking of leaving. Since 2003 this temporary community has built hospitals, reunited families, dug wells, and completely overturned the economy. People have given up farming, or their original trade, to work for much higher wages as drivers or store-keepers for the NGOs.  Now the war is over, and the honeymoon period is coming to an end – and as the population take stock of the situation, they understandably start to question the ethics of NGO intervention.

This is not to say that the population disapprove of the NGOs. The majority remain hugely appreciative of the work of MSF, but there is a perception that we have undertaken these dramatic interventions without ever considering the long term effects of our actions. A Congolese colleague from another organisation said to me “You (MSF) have broken a health system that functioned adequately before hand, and now that you are leaving, the population will be left worse-off than they were before”. To some extent this reflects a very human tendency to forget what things were like beforehand – the fear of an unknown future causes us to romanticise the past. But whether or not there is any truth in his observation, the fear of being left without healthcare is widespread amongst the community. It is essential that we acknowledge and address this fear, because the transfer we are trying to achieve is not just a transfer of medical activity, but also a transfer of the community’s confidence to a new health structure.

I guess I do believe short-term humanitarian interventions can have some lasting benefit, as long as we accept the responsibility of assessing their potential impacts from the start, so that we can try to maximise the positives and minimise the negatives. But in such unstable situations the future is very hard to predict– the original Bon Marché project was expected to last 3 months, and here we are 7 years later. Could they have envisaged that this intervention would reveal a huge unexpressed demand for paediatric care, ultimately requiring a doubling of the capacity of the hospital’s paediatric service? We start these interventions on the basis of imperfect information, and then have to constantly reshape our goals according to the findings that emerge. If at least we do this with transparency, in genuine collaboration with the community and partners – with an awareness of those unmet needs and unexpressed fears – we stand a chance of building something that the community will wish to maintain.

The Congolese give their children the most wonderful names – Dieu-donné (God-given), Dieu-Merci (Thank you, Lord), Glorieuse (Glorious), Desiré (much-desired). And usually everyone knows why they have the name they have. Dieu-donné, for example, may have been born 15 years after the previous sibling, such that the mother believed she could not conceive again, making the birth something of a miracle. It seems a shame that we, the Jonathans and Freds of the world, are unlikely to have such a special relationship with our names.

In the course of one such conversation, I learnt that my colleague Deo-Gracias is the 50th child of his father. Thankfully not all of the 50 were born of the same mother, but if I remember rightly the mothers numbered just 4, such that each one had raised at least 10 children. When I asked Deo-Gracias about this he told me that it’s not as difficult as it sounds, because the older siblings look after the younger siblings, and so after a while the mothers can just take it easy (presumably not before they reach the menopause though).

There is definitely a ‘more-the-merrier’ attitude to child-bearing here, which contrasts quite vividly with our fashion for one or two-child families. It’s clear though that desired number of children is (partly) a function of gender: my female colleagues want fewer children, whilst my male colleagues are more expansive in their outlook, which is unsurprising given that the father performs a fairly hands-off role once the baby is born.

I have to acknowledge though that Deo-Gracias seems a very happy and well-adjusted fellow, and does not obviously lack as a result of the limited quality-time spent with his father. After all, he had what every young boy really wants – a reliable supply of siblings to play football with.

When you are accustomed to living in closed compounds, you develop a long-distance stare; a meditative gaze you adopt automatically when left to yourself. This abstracted state serves two purposes – it allows you to take a little break, to escape for a moment without physically leaving the property; and it helps you overlook the razor wire that charmingly adorns the walls of this and other MSF compounds around the world. This time round, though, my view is a little different – beyond the wire, climbing roses and clumps of deep-green foliage adorn a backdrop of billowy hills.

Perhaps Congo is the closest thing there is to that romanticized image of Africa we have created in the west – tropical forests, gorillas (and guerillas, of course), exploitation, civil wars, dusty road, and lots of dancing. I have numerous preconceived notions of the Congo, all based on novels or historical accounts written by westerners who came here to conquer, enslave or make their name through ‘adventure journalism’.  Then there are those (such as King Leopold) whom we associate with the Congo but who never actually set foot here; and those (Conrad) who experienced the cruelties of the Belgian Congo so vividly that they could only write about what they witnessed in metaphorical terms.  I’m trying to be conscious of these preconceptions so I can let go of them at some point.

Here, for the first time, I will be leading a project. Although there is nothing inherently intimidating about this role, I find myself thinking wistfully about the solid simplicity of the medical roles I have taken on up until now.  We will be closing down Bon Marché, the flagship MSF hospital in Bunia, and transferring all activity to the regional MoH facility. This will involve a lot of negotiating, HR management, and security assessment – and yet I will still be heavily involved in the medical aspects of the programme, in terms of quality assurance before and after the transfer. The role is something of a poisoned chalice, as such changes – with all the HR implications – are inevitably demoralizing for the staff. The next 6 months will undoubtedly be taxing and stressful, but could nonetheless be satisfying. I think.

Thankfully my office is in the hospital grounds, and when I step into the hospital wards I breathe a (paradoxical) sigh of relief, as if somehow I am coming home.  Instead of slippers I put on my stethoscope, and suddenly everything feels familiar and logical. The children are thin and frightened, the mothers care-worn and tired, the nurses are eating their lunch….and all’s right with the world. But then a voice whispers in my ear that the budget revision is due tomorrow, and I reawaken rudely to the reality that I am now a bureaucrat, albeit in doctor’s clothing.