Long journeys in the Democratic Republic of Congo (DRC) are a part of the dizzying extremes in this country dripping with precious minerals but where one in five children die before their fifth birthday. Of the 153,497 km of mapped roads that cross the territory two-thirds the size of Europe, only 2,749 km are paved. As soon as we leave the outskirts of Bukavu, the main city in South Kivu Province, the tarmac ends.
I’m heading for Lulimba, a small, remote town in eastern DRC. It’s 300km away from Bukavu but the journey takes two days in a four-wheel drive vehicle. You can’t fly in as the dirt airstrip, originally cleared by a long abandoned church mission, is reported as uneven and potholed. The jolts along the red dirt tracks, river crossings full of children splashing about (I wonder how many of them carry the worms of schistosomiasis) and short exchanges with armed men en route make it impossible to study the French grammar book open on my lap.
My own journey to DR Congo as a doctor has taken a little longer. Before medical school, I worked as a reporter on frontlines from Bosnia to Afghanistan. Refugees, civil wars, political unrest – these were the stories I wrote about from the field.
Reporters gravitate towards hospitals and clinics because they provide the starkest index of suffering among populations trapped by conflict. I spoke with doctors and nurses behind many frontlines and the more I talked with them, the more difficult it became to simply take notes while they risked their lives to treat the sick and wounded, often with minimal medications and equipment. I put down my notebook and started right back at the beginning, entering a London medical school.
A decade on, as I’m bumped about in the back of a Landcruiser on my journey to Lulimba, driving past a bar painted a marine blue and called Clinique a la Soif (Thirst Clinic), I worry about the sudden increase in my clinical remit. As a doctor in the UK, I manage patients in a busy emergency department but I don’t have to worry about getting hold of antibiotics or a chest X-ray. In DRC, which sits at the bottom of the United Nations’ Human Development Index, resources are scarce. I’ve been warned that as well as seeing patients, I’ll need to keep track of hospital supplies, possibly face widespread cholera or measles outbreaks and help set up treatment for patients with tuberculosis and HIV, both diseases which come with complex pathologies and social issues that are challenging to treat in the UK, let alone isolated Lulimba. I’ve also been given a bright yellow book with simple black and white line drawings: Minor Surgical Procedures in Remote Areas.
When we arrive in Lulimba, our truck carrying about a tonne of precious medications is lurched over at a 45-degree angle, stuck in the mud on the main street. There is no electricity for the squat homes made of mud brick and reed thatch. When the MSF team arrives at the town’s hospital - two single-storey buildings of mud brick roofed in iron - we tell the hospital staff about our plans for free health care. That evening, the staff enthusiastically removes the handwritten posters listing the prices for treatment.
Overnight, word gets around of our arrival. The next day a large crowd of women wearing brightly printed cotton wraps clutching coughing, feverish children, assemble outside the dilapidated outpatient building for a free consultation. Georges, one of the hospital nursing staff, looked a little forlorn in his white coat. “Treatment is free, so now everyone will come!”
Before MSF’s arrival, the hospital saw 231 patients in the month of September. We’ve seen over 300 in our first week.
The hospital is situated on a low rise in lush grassland at the foot of Kivu’s spare Mitumba mountain range. The beauty of the place belies the population’s desperate healthcare needs. On my first day, I found a 14 month-old toddler in the paediatric ward who weighed 5 kilos. He is suffering from marasmus, a severe form of malnutrition with the typical pinched ‘old man’s’ face. He has to share a tattered bed with another sick child as there aren’t enough cots. Sharing a bed is dangerous as the malnourished child’s immune system is unable to fight infections. Pierre, the MSF nurse I’m working with, and I are currently treating the tuberculosis which likely underlies his malnutrition (we can’t test for it so we use a special scoring system to diagnose TB clinically) while starting a careful therapeutic feeding regime. Pierre, who has much experience with these cases, is optimistic.
The hospital’s doctors, Serge and Albert, ask me to attend a caesarian section in the operating theatre. This is a bare room with no electricity or lamp. They depend on a plastic skylight in the roof to see what they’re doing during the day, and use head torches during the night. They don’t expect the baby to survive as the mother’s uterus was ruptured. They were performing the operation to save the mother’s life. But with a few puffs of room air delivered by a bag and mask to inflate the baby’s lungs, the little girl let out a hearty cry and both mother and baby are doing well.
Underlying Lulimba’s health problems is DRC’s chronic conflict. In 2009, the hospital was attacked by an armed group that destroyed or pillaged many of the building’s meagre resources. But if the needs are great around Lulimba, one can only imagine those in Congo’s even remoter areas. To get to Lulimba, we had to drive through an area called Foret 17, notorious for banditry and the constant to-ing and fro-ing of the many armed groups that roam South Kivu. At an isolated health post nearby, the nurse in charge said recent fighting had driven hundreds of villagers into the forest. They will have no help to fight the malaria, pneumonia, diarrhoea and other treatable illnesses that continue to cause so many deaths in Congo.
This post was first published online by the Guardian