(Not all) Doctors Without Borders

Izzy is a health promoter from the UK. She's out in the Democratic Republic of the Congo, where she and the team are working to prevent outbreaks of disease...

My dad’s response to me telling him that I’d received my mission posting out here was: “Oh such great news! What’s DRC?” 

After a bit of “you’re not going”, and “why can’t you just do something normal?”, and some minor visa-related hurdles, I’ve ended up here – the bustling metropolis of Kibombo, Democratic Republic of Congo (DRC).

Kibombo town centre on a very quiet Sunday

Photo: Izzy Scott Moncrief/MSF

When people think of Médecins Sans Frontières, they think of a bunch of courageous doctors, running across the front line of a conflict zone, bombs going off all around, carrying a stretcher or three. I mean, they’re not wrong – this does happen. But that’s not everything that defines MSF. In the run up to my departure from Edinburgh, I was asked countless times whether I was a doctor, and received looks of surprise when I said no.

The “not bad” view from the MSF house in Bukavu (Mission capital)

Photo: Izzy Scott Moncrief/MSF

I’m out here working as a Health Promotor, or “IEC Officer” (Information, Education and Communication). Basically, when you have a public health issue, for example, an outbreak of cholera, or an area in which malaria is endemic, we come up with and implement strategies for behaviour change within the population to prevent the transmission of these diseases. Respectively, this could include getting people to wash their hands with soap before eating and after using the toilet etc.; or sleeping under mosquito nets at night.

I could be biased and say that we almost wouldn’t need doctors at all if health promotors can get onto the case early to prevent disease outbreaks from happening…

View from the plane, heading to Kibombo from Bukavu

Photo: Izzy Scott Moncrief/MSF

Anyway, my MSF assignment began at the end of October in the DRC (this blog post has been sitting partially written for a long time). My role is “flying”, which unfortunately doesn’t mean that I have suddenly sprouted wings, but rather that over the course of nine months I will split my time across a number of projects.

I’m currently one of the four international staff working in the mHAT team – a mobile unit, with the main purpose of screening people in remote and difficult-to-access places for Human African Trypanosomiasis (HAT) – Sleeping Sickness.

Since August, the mHAT project has been a part of the South Kivu mission of MSF Holland (MSF-OCA), despite being situated in Maniema Province, not actually South Kivu.

The plane, from the plane

Photo: Izzy Scott Moncrief/MSF

And what is HAT?

HAT is nasty. It falls under the class of infections known as Neglected Tropical Diseases (NTDs), which are largely prevalent in tropical/subtropical regions where populations live in poverty with inadequate sanitation, and are in constant close contact with disease vectors through specific livelihoods and habits (such as hunting, fishing, washing clothes in the rivers, open defecation etc).

HAT is caused by a parasite which is transmitted to humans by the bite of a Tsetse fly. There are two strains of the disease, but the one we’re dealing with here in DRC is Trypanosomiasis gambiense – largely prevalent on this side of the Congo Basin.

The symptoms initially are pretty similar to malaria, such as fever, headache and joint pain (this complicates things a bit out here, given that malaria is endemic).

If HAT cases are not treated, the parasite passes the blood-brain barrier into the central nervous system, causing neurological changes including disturbing sleep cycles, erratic and psychotic behaviour, seizures, coma, and death.

So hopefully that clears up a bit the reasons for this project. If we find people with the disease, we take them back to the local hospital and provide the relevant treatment, and everyone is happy. 

A “not heavily Instagrammed” tsetse fly, shortly after it bit me

Photo: Izzy Scott Moncrief/MS

Life in Kibombo

So, Kibombo. It’s a big-ish town, by Maniema’s standards, with a church, mosque, what sometimes seems like 500 schools and a sort-of pub called “Les Belles Etoiles” (“The Beautiful Stars”). 
I think it has this name because it’s basically the area outside an enterprising person’s house, where there is no roof, so you just get to enjoy your warm beer beneath those beautiful Congolese stars that inspired the name (after having opened your beer on a brick or alternative sharp object, given that the bar doesn’t seem to have any sort of bottle opener). Speaking of beer, it’s pretty good here. The house favourite is the aptly named “Legend”. “Brewed for legends, by legends” (would be my tagline if it were our say…).
MSF is the only NGO working in the area, and we definitely stand out, with our convoys of white land cruisers and motorbikes piled high with equipment heading off to the field for explos (explorations) and screening trips every couple of weeks. 
The office is about 400m from the house which is convenient, but it is still impossible to do that walk without encountering various groups of children who have clearly come across a heap of different MSF expat staff over the years, given the number of different names I get called. “Chiara”, “Marius” and “Madame John” are probably the recurring favourites.

Bit of a view of the house from the outside

Photo: Izzy Scott Moncrief/MSF

The expat house sits nicely in the middle of a large green patch in the village. Once you’ve adapted to the pit latrine, the house is really nice, with very refreshing outdoor showers and good food.

Clementine and Marlene who cook for us are awesome. They made me cake for my birthday, somehow, on a charcoal fire – twice, in fact, since everyone got the day wrong the first time.

Marlene with my birthday cake, including MSF logo :D

Photo: Izzy Scott Moncrief/MSF

Luckily, I fairly quickly managed to establish a TV-sharing system with my all-male housemates, so it’s not just random football matches or West African music videos every night. “Ivanka” the cat is a solid part of the furniture now. She’s sometimes nice and semi-friendly, but mostly just creeps around ripping the tails off small lizards, and sits in on important Arsenal matches.

The guards killed what was apparently a Black Mamba the other night as it came into the house. Ivanka obviously ran away, rather than come to our aid.

Joseph the guard with his Black Mamba victim

Photo: Izzy Scott Moncrief/MSF

Given where the house is situated, it’s not that easy to lie-in at the weekends without being woken up by various sorts of animals, bicycle bells or families walking past on their way to market or church. And Kibombo isn’t exactly heaving with things to do outside of work to fill these long days, apart from write blog posts, watch movies and go to the Belles Etoiles.

Saying that, a few of us have a good workout regime going, with a couple of nice running routes and a morning circuits session which is sufficiently grueling. It’s good to provide a bit of structure to a day which, for me, currently involves batting through loads of new concepts, in French, which I currently can’t speak or understand that well.

I’m sure it’s improving…The crazy Kibombo party scene doesn’t always seem that appealing, so Saturday is now film night (although I’m conscious of my slightly rogue movie collection). Around Halloween we watched “The Shining”, which could have been a good choice, but I’m not sure those very cult, “scariest movie moments of all time” quite translated into the 6 different languages present at the film viewing.

The Congo River, a conveniently nice setting for my Instagram, is only about 5km away from the base, and something we’ve tended to do with visitors from other projects when they’ve made it all the way here is to take them down that way on Sundays. 



Nearest view of the Congo River

Photo: Izzy Scott Moncrief/MSF

Last time I was down there, I really awkwardly slipped over and got covered in mud, to some laughs, and shouts of “Mzungu! Polepole!”. I guess it was pretty funny after I established that I hadn’t broken a limb. 
We have the luxury of being able to walk around town, or to a few of the local landmarks, like the water source and the football field. Guaranteed there will be a mob of small children in tow most of the time. Although this only feels threatening when I’m running, and there is a risk that one particular seven-year-old is going to beat me in our habitual sprint finish.

The MedCo (Medical Coordinator) came to visit and received a warm welcome

Photo: Izzy Scott Moncrief/MSF

I have a fairly regular dialogue with this lady whenever I walk past, where I attempt some Swahili, she laughs and waves, and we part ways. She’s one of a handful of tailors in the town, although I’ve yet to have anything made…maybe one day.

A Kibombo tailor

Photo: Izzy Scott Moncrief/MSF

Occasionally on our walks, I find myself being asked to show off my football talent…Yes, the children in the photo look distinctly underwhelmed, but there were at least 20 kids to the left of the photo (below)  who were SERIOUSLY impressed…

“Mad skills”

Photo: Izzy Scott Moncrief/MSF

So, there you have a brief snapshot of the people, places and things in Kibombo, as well as the reasons why we’re here. I referred to it as home the other day, so clearly something is going right.