So far I haven’t posted anything about my living conditions in the DRC. They are not that different than what I blogged about on my last MSF mission. The team here is bigger so we have a few more outdoor showers and latrines plus the luxuries of running water, round the clock electricity and one almost western style toilet. The biggest difference for me is that my movements outside the compound are much more restricted on this assignment. The political and military situation here is in an ongoing state of flux.
For security reasons, other than daily Landcruiser rides to and from the hospital, ex-pats can only leave the compound on foot during daylight plus have to travel in pairs, carry a walkie-talkie and stay on the main street within half a mile of the compound. That’s a pretty short leash to be on so it was a huge treat when I got to go on a road trip to Rwanguba last week. On the morning of my post-call day off, I heard that our project chief, medical chief and an internist doing hospital QA work (gathering data, looking at outcomes, trends, etc) for MSF were going to visit a smaller hospital for the day so I asked if I could tag along. Fifteen minutes later I was heading out south on the same road I came in on two weeks earlier, accompanied by three French women and a Congolese driver.
The first five km of the trip was on the road I travel every day. As the road rises from the village center toward the hospital, you can see Rutshuru and its surrounding villages spread out across a wide flat valley surrounded by mountain ranges generated by a combination of volcanic activity and plate tectonics. The entire valley is green, much of it cultivated. The road passes along an eclectic collection of buildings including mud huts, brick and stone buildings with metal and tile roofs, a few decaying structures either left half built or half destroyed, a large compound with a UNHRC (United Nations Human Refugee Committee) sign, the largest compound along the road locally. Despite the limited number of motor vehicles on the road, we passed two vehicles where the drivers are talking on their cell phones. Distracted driving isn’t an American invention. I’ve seen Congolese on motorcycles, steering with one hand to avoid the bigger pot-holes while holding a phone up to an ear with the other.
South of the hospital we passed more of the same, a couple of large schools, some municipal government buildings, a banana grove where on my previous trip from Goma I had seen locals using the five-foot-long leaves as makeshift umbrellas. We eventually reached a turn-off with a few local stands selling bananas, cigarettes and various sundries near a small concrete obelisk with painted arrows, names and corresponding distances including one announcing "Rwanguba Hospital 14km”.
We took a left turn onto what was disappointingly an even bumpier road. Like the main road, it had been paved at some point though it was hard to know when. For the next 14 km we ascended through a river valley filled with activity including a fish farm and a wide variety of agriculture. There were no other cars on this road but we passed a few motorbikes, a dozen tchukudus (a local mechanical phenomena which has been described as a wooden bicycle which is like describing a computer as an electronic calculator...I may make a blog posting about them sometime but meanwhile you should google them) loaded with produce (sugar cane, bananas, bamboo, potatoes), about a half dozen beat up bicycles all which appeared to have only one gear and a large number of people walking, most of them carrying fairly impressive loads, many of them children and adolescents (I made a note to myself that I should have my kids do a few more chores when I get home). Midway we passed a clearing with some type of community center and an open air market where vendors and buyers were beginning to gather. As we traveled further up the valley, the scenery became even more verdant and lush. On either side of us rose mountain peaks covered with a variety of exotic greenery, as unbelievably beautiful as a Hollywood background for “Jurassic Park” or “King Kong” but with the appearance of authenticity and natural disorder that just can’t be duplicated using CGI.
When we reached the hospital, our first stop was at the head administrator’s office. The hospital is actually a collection of about 8 to 10 buildings on a ridge. From this ridge, foot paths lead off in all directions to other nearby hillsides where there are residences all along the valley, many of them farms. We walked up three steps to a one story concrete building and met the hospital administrator, a slender, soft spoken man with glasses. He was dressed casually with a simple gold wedding band on long slender fingers that made me think of a pianist.
He invited us into his office in a room about 20 ft by 15ft with the door painted the same green as the window frames, the walls blue on the lower half like a chair rail transition, white on the upper half, peeling all over. I liked his desk a lot, simple but well constructed out of beautiful African mahogany wood that is only seen in high end custom pieces in the US, much like a lot of the furniture I have seen here. The laptop on his desk was plugged in and powered up. In the far corner of his office was a good sized battery bank tied to an inverter with a regulator on the wall and a thick conduit exiting the ceiling to a solar panel or a generator or both. There was a top loading freezer next to the battery banks that I assumed was for routine storage and never plugged in as it had a number of things stacked on top including some books, a globe and a 24" non-flat screen TV still in the box. The walls had a variety of graphs, schedules and charts with statistics about immunization, hospital numbers, etc. taped up plus a hand written sign talking about the signs and symptoms of 'fievre ebola' and isolation precautions. I noted the corners of the Ebola sign were browned and the tape edges curled. I hoped that this sign was older than the other papers and did not reflect an active problem.
We met with him for the next half hour, then met with the medical director for another half hour in a different office that was slightly bigger than the administrator’s. I listened attentively but I'm not 100% certain of what all was said. My French improves daily but on average I still only understand about 50% of what I hear (with the range being from sometimes understanding 90% if someone is speaking slowly and directly to me to sometimes missing the point all together and getting the message exactly backwards). As best I could make out, the hospital in Rwanguba is a small one with about 60 beds and refers a number of patients to the MSF hospital in Rutshuru. The medical staff is made up of three local general MDs. They have an OR that can do up to three cases per day and they perform about 20 c-sections each month. Like many small rural hospitals, including those in the US, they have difficulties with issues of volume and attracting experienced staff as well as feeling an obligation to serve the local community.
Next we had a tour of the hospital grounds. The buildings in the hospital compound were a combination of brick or stucco with metal frame windows. The maternity ward is in the nicest and best kept-up of the buildings. When we passed through it, the central room was being used for a well attended pre-natal instruction class. The medical ward beds were in an older building with mosquito nets overhanging even older metal hospital beds. The pharmacy shared a large room with general storage but seemed well stocked, with medications ranging from pre-natal vitamins to ceftriaxone, a commonly used intravenous antibiotic. The two operating rooms had a mechanical device that is common here for delivering concentrate oxygen at a mildly increased positive pressure but no real anesthesia machine. I felt grateful and a bit spoiled for having the MSF operating rooms at my disposal, with equipment for sterilization, standardized instrument trays, anesthesia machines and anesthetists. I was more than a little impressed that the local doctors here who have limited surgical training and less technical support are doing 20 c-sections a month.
Before we leave the hospital, there is a patient referral. A premature baby who is quite small, even by local standards, hasn't taken to breast feeding and there is concern he won’t survive. In Rutshuru, we can feed babies who won’t eat through a tiny naso-gastric tube but for some reason that is not an option here. After a conversation between our medical chief who is also a nurse and the baby's mom and dad, they agree to ride back with us to Rutshuru.
The ride back seemed even bumpier as I worried about the baby being shaken and saw how tired the mom looked, just a few days after giving birth. It would be better for them if the road was paved, I thought. We passed the open air market at the community center that had now filled up. The stalls were packed and there were more people and bikes and tchukudus on the road now coming and going in all directions. I thought more about the road. We had only seen two other cars on the road that day, one from another NGO and a pick-up filled with soldiers. Would it be better for this community, where very few own a car but everyone uses the road for walking, where so many goods are moved using non-motorized carriers, where children routinely walk and play along it, if it suddenly were paved tomorrow and the NGO Landcruisers and the soldiers’ pick-ups could drive faster? I have little doubt that someday the people of the DRC will be more prosperous and the road to Rwanguba will eventually be paved again. It will be interesting to see how the area changes when that happens, what is gained and what is lost. But for right now, the road seems to be working for the community as it is.
Next time I’ll talk about the burn unit here.