If you are given 1 chicken, it is a sign of appreciation. If you are given a pair – a rooster and hen so they can mate – that has real value and you must be extra special. If you are given 5 CHICKENS, it is really just too much!!!
…that is what was explained to me as I accepted a box full of chickens on behalf of MSF following a community meeting in the village of Katonta a few weeks ago. Seriously…5 chickens in a box! Check out these pictures.
Over the past months, I have invested a lot of time trying to ensure that the reasons for which MSF is leaving are clear to our partners, local authorities and the community in general. This takes many forms…informal discussions with staff at the hospital, official meetings with the village authorities and, of course, community meetings.
These are never easy. Essentially the equivalent of a town hall meeting, it involves at least 2 hours in a hot and sweaty school room answering questions and trying to explain to the community why they are losing their free health care. Imagine the uproar if you were to do this in Canada! Everyone is invited: the local health committees, Ministry of Health (MoH) nurses from the health center, MSF community outreach workers, the village chief, traditional birth attendants, the local Red Cross, school principles, priests, traditional healers.
Since I called the meeting, I sit up front and face the crowd. As many can’t speak French, my translator starts to convert my message into the local dialect and off we go. I’ve given this speech a few times, so now it comes a bit easier.
We talk about how things have changed over the past 5 years. How there is no longer war, the displaced population has all gone home and we have entered a developmental stage. How MSF is an emergency relief organization and this doesn’t fit our mandate. How the MoH is now present, trained and will take over as of May 31st.
How the free care that MSF provides is not sustainable. How the MoH will install a user fee system. How we will make a 3 month drug donation to help in this transition period. How it is THEIR village, THEIR health centre, THEIR family…and that it is time for them to step up and take ownership.
Not my favorite part
This is a pretty tough message when I know that the level of care will drop. That the MoH is present but is not nearly as effective as MSF. That even a nominal user fee (20 cents for a consultation!) will exclude a large portion of the population and that a C-section will cost an astronomical and unobtainable $30. That emergency referrals from the health centre to the hospital will be by bicycle and take half a day. That there will be more drug ruptures and the MoH staff will not be paid as well or as often, or at all.
From my perspective, these are the poorest people I have ever seen and most really have nothing. Yet it is all relative and while it might seem like a pretty desperate situation to me, this population has known much worst and not so long ago. The fact that there is a Ministry of Health, that they are present and that they are willing to take over, is a huge sign of progress.
So far, my message seems to be getting through as people know that we are leaving, understand why and have an idea about how things will look after we are gone. Everyone is sad and wishes we could stay…but people are not angry. I ask them to think of this as not only an end, but a new beginning. The beginning of a more sustainable system, a truely Congolese system. They understand that health care is not normally free and they are thankful to have had MSF come to their community in their time of need.
…and giving me 5 chickens is their way of showing this.